Abstract

Effective postoperative analgesia is crucial for patient recovery following major abdominal surgery, influencing not only patient comfort but also clinical outcomes including respiratory function, mobilization, and hospital length of stay. This prospective, randomized, double-blind study compared the efficacy and safety of continuous epidural infusion of 0.125% ropivacaine with 1 mcg/ml fentanyl versus 0.125% bupivacaine with 1 mcg/ml fentanyl for postoperative analgesia in patients undergoing major abdominal surgery. One hundred twenty patients aged 18-75 years, ASA physical status I-III, scheduled for elective major abdominal surgery were randomly allocated using computer-generated randomization to receive either ropivacaine-fentanyl combination (Group R, n=60) or bupivacaine-fentanyl combination (Group B, n=60) via continuous epidural infusion at 5-10 ml/hr for 48 hours postoperatively. The epidural catheter was placed at T8-T10 level preoperatively. Primary outcomes included pain scores at rest and during movement, assessed using Visual Analog Scale (VAS) at 2, 6, 12, 24, and 48 hours postoperatively. Secondary outcomes included degree of motor blockade assessed using modified Bromage scale, hemodynamic parameters (blood pressure and heart rate), rescue analgesic requirements, time to first ambulation, patient satisfaction scores, and incidence of adverse events. Both groups demonstrated comparable analgesic efficacy with mean VAS scores at rest ranging from 2.1±0.8 to 3.2±1.1 in Group R and 2.0±0.7 to 3.1±1.0 in Group B (p>0.05 at all time points). VAS scores during movement were also similar between groups. However, Group R showed significantly less motor blockade with only 8.3% of patients experiencing Bromage score ≥1 compared to 21.7% in Group B (p=0.042). Hemodynamic stability was better maintained in Group R with significantly lower incidence of hypotension requiring intervention (13.3% vs 26.7%, p=0.048). Time to first ambulation was shorter in Group R (18.4±4.2 hours vs 22.8±5.6 hours, p<0.001). Patient satisfaction scores on a 10-point scale were significantly higher in Group R (8.7±1.2 vs 7.9±1.4, p=0.001). The incidence of nausea, vomiting, and pruritus was similar between groups. No serious adverse events were reported in either group. This study demonstrates that while both combinations provide effective and comparable postoperative analgesia following major abdominal surgery, the ropivacaine-fentanyl combination offers distinct advantages including reduced motor blockade, better hemodynamic stability, earlier mobilization, and higher patient satisfaction, making it a preferable choice for continuous epidural analgesia in this surgical population.