Motor block during patient-controlled epidural analgesia with ropivacaine or ropivacaine/fentanyl after intrathecal bupivacaine for caesarean section

We compared patient-controlled epidural analgesia(PCEA) withropivacaine alone or combined with fentanyl in terms ofanalgesicefficacy, motor weakness and side-effects in patients whohadreceived spinal anaesthesia for elective Caesarean section.ASA Ipatients received combined spinal–epiduralanaesthesia and wererandomly assigned, in a double-blind study,into two groups afteroperation: group R (n=23) received PCEAropivacaine0.1%, bolus 5 mg, lockout 15 min,3 mg h^–1background infusion, and group RF(n=24) received PCEA 0.1%ropivacaine/fentanyl2 µg ml^–1 at identicalsettings. Pain andsatisfaction on a 100 mm visual analoguescale (VAS) andside-effects were noted. Incidence of motorweakness (Bromagegrade 1 or higher) was 48% (11/23) at8 h in group Rcompared with 13% (3/24) in group RF (P=0.025).Painscores on movement were lower in group RF at 8 and 12 hand atrest at 6 and 8 h (P<0.05 for each comparison).Analgesicconsumption was less in RF (P=0.041), but there wasnodifference in time to first request for supplementary analgesia.Patientsatisfaction with postoperative analgesia (mean (SD))washigher in RF (79 (23) vs 57 (29) mm,P=0.045).Caution should be exercised using ropivacainePCEA after spinalbupivacaine for Caesarean section, because its reputedmotor-sparingproperty may be unreliable. Br J Anaesth2000; 85: 468–70 ^* Corresponding author:University Department of Anaesthesia,Leicester General Hospital, LeicesterLE5 4PW, UK