Epidural Ropivacaine versus Ropivacaine with Fentanyl for Analgesia in Paediatric Laparoscopic Surgeries: A Double-Blind Randomized Comparative Study
Analgesia in Paediatric Laparoscopic Surgeries
Background: Laparoscopic surgery in children has beneficial outcomes like decreased pain and less tissue manipulation. That is why we get better outcomes and better healing. In abdominal surgeries, local anaesthesia and opioid by epidural route prove to have a significant analgesic effect. The aims is to compare the hemodynamic effects, use of rescue analgesia after adding fentanyl to ropivacaine in single bolus epidurals in laparoscopic surgeries of paediatric patients. Settings and Design is Randomized double-blind study. Subjects and Methods: We conducted a study in 1 to 5 years age group patients undergoing laparoscopic procedures under general anaesthesia, divided into two groups after randomization, Group I has been given single bolus dose epidural ropivacaine (0.2%) and Group II has been given single bolus dose epidural ropivacaine (0.2%) with fentanyl (1mg ml−1). Hemodynamic stability, Intra and postoperative analgesic needs were compared. Statistical analysis used: We have used paired ”t” test for comparison of continuous data at different time intervals in a group and unpaired “t” test for comparison between two groups. We have used chi-square (χ2) for comparison of discrete (categorical) variables. Results: We have found a significant rise in heart rate and mean arterial pressure at all-time intervals (p<0.001) except just after induction (5 min), but the rise was more significant in Group I. Intraoperative fentanyl requirement was significantly higher (15.54 3.77µg vs 0.74 1.91µg) in Group I. Similarly in the postoperative period the rescue analgesic was also required early (2.27 0.50hrs vs 7.13 0.81 hrs) and more (412 32mg vs 284 27 mg) in Group I. Conclusions: It was concluded that single-dose epidural ropivacaine with fentanyl provides more hemodynamic stability with less need of intra and postoperative rescue analgesics.
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