Add on fentanyl to ropivacaine enhances Caudal Epidural Block Duration and Efficacy in spine surgeries: Study

A sole injection of local anesthetic as a caudal epidural block relieves pain for 2-4 hours. This timeframe can be prolonged by incorporating additional agents like opioids, ketamine, α2 agonists, and adrenaline. Recent research paper examined the use of adjuvants, specifically fentanyl, to extend the duration of pain relief provided by a single injection of the local anesthetic ropivacaine as a caudal epidural block. The study aimed to compare the quality and duration of pain relief using a combination of caudal epidural ropivacaine and fentanyl versus using ropivacaine alone in patients undergoing lumbosacral spine surgeries.

The study included 56 ASA grade I and II patients who were randomly divided into two groups. Group R received 20 ml of 0.2% ropivacaine, while Group RF received 20 ml of 0.2% ropivacaine combined with 50 micrograms of fentanyl as a caudal epidural block. The results showed that the addition of fentanyl to the ropivacaine injection significantly prolonged the duration of analgesia. The mean time until the first rescue analgesia was required was 7.30 hours in the RF group compared to 6.68 hours in the R group. The visual analog scale (VAS) scores were also lower in the RF group throughout the 24-hour postoperative period, with a maximum VAS of 5.87 at 4 hours compared to 5.96 at 6 hours in the R group.

Comparison of Analgesia

The intraoperative fentanyl requirement was similar between the two groups. However, in the postoperative period, the total amount of rescue analgesia (fentanyl, diclofenac, and tramadol) administered was comparable between the groups. No adverse effects or complications related to the caudal block or the administered drugs were observed in either group.

Study Conclusion

The study concludes that the addition of 50 micrograms of fentanyl to 20 ml of 0.2% ropivacaine for ultrasound-guided caudal epidural block in patients undergoing lumbosacral spine surgeries results in longer duration of analgesia and lower VAS scores over the postoperative 24 hours, without increasing the incidence of adverse effects.

Implications of the Findings

The findings suggest that the combination of ropivacaine and fentanyl as a caudal epidural block provides superior postoperative pain relief compared to ropivacaine alone in patients undergoing lumbosacral spine surgeries. This technique can be a valuable tool in managing postoperative pain and improving patient outcomes in this patient population.

Key Points

1. The study examined the use of the adjuvant fentanyl to extend the duration of pain relief provided by a single injection of the local anesthetic ropivacaine as a caudal epidural block in patients undergoing lumbosacral spine surgeries.

2. The study included 56 ASA grade I and II patients who were randomly divided into two groups - Group R received 20 ml of 0.2% ropivacaine, while Group RF received 20 ml of 0.2% ropivacaine combined with 50 micrograms of fentanyl as a caudal epidural block.

3. The results showed that the addition of fentanyl to the ropivacaine injection significantly prolonged the duration of analgesia, with the mean time until the first rescue analgesia being 7.30 hours in the RF group compared to 6.68 hours in the R group. The visual analog scale (VAS) scores were also lower in the RF group throughout the 24-hour postoperative period.

4. The intraoperative fentanyl requirement was similar between the two groups, but in the postoperative period, the total amount of rescue analgesia (fentanyl, diclofenac, and tramadol) administered was comparable between the groups.

5. No adverse effects or complications related to the caudal block or the administered drugs were observed in either group.

6. The study concludes that the addition of 50 micrograms of fentanyl to 20 ml of 0.2% ropivacaine for ultrasound-guided caudal epidural block in patients undergoing lumbosacral spine surgeries results in longer duration of analgesia and lower VAS scores over the postoperative 24 hours, without increasing the incidence of adverse effects.

Reference -

Rajwade S, Dubey R, Khetarpal M, et al. (October 06, 2024) Comparative Analysis of the Postoperative Analgesic Effects of Caudal Epidural Injection of Ropivacaine Combined With Fentanyl Versus Ropivacaine Alone in Lumbosacral Spine Surgeries: A Randomized Double-Blinded Study. Cureus 16(10): e70963. DOI 10.7759/cureus.70963