Comparative study of continuous infusions of Ropivacaine v/s Ropivacaine + Fentanyl for post thoracotomy analgesia in 50 patients

Background: Epidural opioids have been widely used for post thoracotomy pain relief. One such drug is Fentanyl, a short acting lipophilic opioid analgesic, structurally related to Pethidine for its opioid activity. Adding Fentanyl, as an adjuvant to Ropivacaine, also reduces total consumption of Ropivacaine and incremental doses of rescue analgesics. Materials and methods: 50 patients of either sex aged 18-60 year belonging to ASA class II-III scheduled for elective thoracotomy were included in this study and divided into two groups: Group R receiving 0.1 ml/kg/hr of 0.2% Ropivacaine continuous epidural infusion for 24 hour and Group RF receiving 0.1 ml/kg/hr of 0.2% Ropivacaine + 4 µg/ml Fentanyl continuous epidural infusion for 24 hour. Results: There was no significant difference between two groups regarding to Age, sex, height, weight and ASA grade and preoperative vitals as well as VAS score at rest. There was highly significant difference between groups at 30 minute and 6 hour regarding to this variable with P <0.001. Patients in group RF were more comfortable during PEFR measurement than group R. Conclusion: A continuous thoracic epidural infusion of 0.1 ml/kg/hr of 0.2% Ropivacaine + Fentanyl 4 µg/ml provided better pain relief than 0.2% Ropivacaine alone after thoracotomy; both at rest and during spirometry. The use of 0.2% Ropivacaine alone was associated with worse pain control during spirometry, larger consumption of IV Diclofenac Sodium and worse performance during spirometry. Addition of Fentanyl to Ropivacaine for continuous epidural analgesia in post thoracotomy patients provides better pain relief and improves spirometry performance.