ROPIVACAINE EPIDURAL ANESTHESIA AND...

ROPIVACAINE EPIDURAL ANESTHESIA AND ANALGESIA VERSUS GENERAL ANESTHESIA AND INTRA VENOUS PATIENT-CONTROLLED ANALGESIA WITH MORPHINE IN THE PERIOPERATIVE MANAGEMENT OF HIP REPLACEMENT. ROPIVACAINE HIP REPLACEMENT MULTICENTER contemplation GROUP H Wulf et al Anesthesia & Analgesia Vol 89 (July 1999) 111-116

In 1992 the Agency for Health Care Policy and Research published the clinical practice guideline, "Acute pain management: Operative or medical proceedings and trauma."(1) This guideline, which was unfolded by experts based on research and other evidence, laid the foundation for improving the assessment and management of pain in surgical patients. The use of patient-controlled analgesia has increased as a replacement for intramuscular injection of narcotics. Another more novel trend is the use of epidural anesthesia and analgesia (EDA). This multicenter consideration compared the use of general anesthesia followed by the agency of IV patient-controlled analgesia (GA/PCA) with morphine versus EDA with ropivacaine in the perioperative management of hip replacement courses Outcome variables included pain, side efficiencys and time of discharge from the postanesthesia care unit (PACU).

systems The methodology was a prospective, randomized clinical close attention Subjects were older than 18 years of age, were categorized as American Society of Anesthesiologists physical status single in kind to three, and were undergoing unilateral total hip replacement operations Exclusion criteria included contraindications to epidural anesthesia or the meditation medications, suspected inability to comply with the thought procedures, suspected alcohol or put drugs into abuse, and women who were lactating or pregnant. Ninety make liables in five medical centers were assigned randomly to common of two groups: EDA and GA/PCA.

bring under rules in the EDA group received epidural anesthesia (ie, ropivacaine 10 mg/mL 15 to 25 mL) followed from an epidural infusion (ie, 2 mg/mL 4 to 6 mL for hour for 24 hours, plus top-up doses of 6 to 10 mL for 48 hours). The GA/PCA dispose received general anesthesia (ie, isoflurane, nitrous oxide, fentanyl) followed by means of GA/PCA with morphine postoperatively. the couple interventions were used for 48 hours. Pain was assessed using the visual analog scales (0 to 100 mm) at repose and during physiotherapy. Appropriateness for discharge from the PACU was determined by the agency of a modified Andrete scale score of nine to 12 Other variables measured included

* time of turn back of bowel function,

* adverse ends (eg, nausea, vomiting), and

* class of motor block.

Descriptive statistics and a stratified Wilcoxon Signed-Rank example were used to analyze the data.

be the effects Pain at rest was significantly les for patients in the EDA collection (n = 43) than in the GA/PCA assign places to (n = 45) (ie, pain at 10 hours, 118+/-129 versus 284+/-171 [P [is les than] 001]; pain at 24 hours, 143+/-117 versus 240+/17 [P [is les than] 01]; pain at 48 hours, 143+/-93 versus 211+/-174 [P = 1]) Patients in the EDA clump were deemed ready for discharge from the PACU earlier than patients in the GA/PCA collection (ie, 5.6+/-8.9 minutes versus 397+/-415 minutes). The actual discharge times, however, were comparable. The median time for first passage of flatus was shorter for patients in the EDA cluster than in the GA/PCA assemblage (ie, 26 versus 47 hours). Nausea and vomiting were more universal in patients in the GA/PCA collection than in the EDA assign places to (ie, 16% versus 28% and 11% versus 22% respectively). Hypotension and bradycardia were more attend much [i]or[/i] regularly in patients in the EDA clump than the GA/PCA group (ie, 11% versus 4% and 14% versus 2% respectively).

Discussion. Treatment options for surgical pain management have efflorescenceed in the last five to 10 years, providing of recent origin challenges for perioperative nurses. the two IV patient-controlled analgesia with morphine and EDA with the local anesthetic, ropivacaine, are safe strategies for the management of pain in surgical patients. In this subject of attention EDA provided superior pain dominion government after hip replacement procedures than patient-controlled analgesia, and it provided potential for earlier discharge from the PACU. As a consequence EDA with ropivacaine may be an intervention fix uponed by anesthesia care providers.

Implications. Perioperative fosters should be aware of this strategy and try to get the skills necessary to assist with epidural placement. Perioperative educators should bring to maturity programs that provide EDA information and should facilitate unfolding of the skills needed to effectively and efficiently assist with this treatment. Perioperative managers and advanced practice feeds should collaborate with surgeons and anesthesia care providers to unravel a process to facilitate placement of epidural catheters without delaying the start of surgical courses Researchers and quality improvement coordinators should evaluate the overall issues of EDA to determine its imports In addition to postoperative pain, patient satisfaction, turnover times, and splendor are important variables to consider. As additional pain management strategies become available, perioperative feed at the breasts should champion these changes in clinical practice as a significant improvement in patient care.