Comparison of continuous infusion of epidural opioid and local anesthetic and continuous infusion plus intermittent bolus for postoperative analgesia in orthopaedic patients

Abstract

This study has been performed on 7 males and 4 females, grade II-III patients between the ages of 17-76 who had undergone orthopaedic tibia and femur surgery. The mean weight of the cases was 64.5 ± 13.1 kg, and height was 169.7 ± 7.6 cm, an epidural catheter was inserted between L<inf>1</inf>-L<inf>4</inf> intervertebral spaces after operation. Postoperative analgesia was started with technique of continuous infusion in 6 patients (Group C) and continuous infusion plus intermittent bolus in 5 patients (Group C + B). Lifecare Provider 5500 portable infuser was used for this procedure. Analgesia was provided with 40 cc bupivacaine 0.5% plus 1 mg fentanyl solution diluted in 120 cc normal saline. The infusion pump was programmed for 6 cc/hour continuous infusion in 6 patients (Group C) and 4 cc/hour continuous infusion plus 4 cc intermittent bolus in every 200 minutes in 5 patients (Group C + B). Visuel Analog Scale (VAS) was used for definition of postoperative pain at 1st, 4th, 8th, 24th and 48th hours. The total amount of epidural infusion solution was found 305.33 ± 94.49 cc in Group C, whereas 246.25 ± 5.05 cc in Group C + B at the end of 48 hours. While postoperatively in the first 24 hours, the number of patients with 0-1 VAS were more, but in the second 24 hours there were less patients in Group C. In addition, the daily cost of treatment was 25% more cheaper in Group C + B with comparison of Group C. As a result of this study, we concluded that continuous infusion plus an intermittent bolus technique was better than a continuous infusion method, both with regard to analgesia quality and cost.