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COMPARISON OF CONTINUOUS AND INTERMITTENT ADMINISTRATION OF EPIDURAL BUPIVACAINE FOR POSTOPERATIVE PAIN MANAGEMENT FOLLOWING MYOMECTOMY
ABSTRACT
BACKGROUND: There are two techniques of administration that are commonly
employed in the use of bupivacaine via the epidural route; continuous infusion and
intermittent bolus injection. At present there is no consensus in the literature regarding
the superiority of one technique over the other in terms of analgesia and accompanying
side effects. Some studies report that patients receiving intermittent administration of
bolus doses maintain a more extensive block and report marginally better analgesia while
other studies found that a continuous infusion produces a constant block to maintain
analgesia with reduced cardiovascular disturbances. Presently, there is no consensus
among researchers regarding which of the two techniques is most appropriate for
postoperative pain management. Therefore, this study compared the efficacy of
postoperative pain relief and side effects of the two techniques of administration of
epidural bupivacaine in postoperative pain management following myomectomy.
METHODS: Following the approval of the institution ethical review committee, a
randomized double-blind study was conducted on 70 ASA physical status I and II adult
patients scheduled for myomectomy under epidural anaesthesia. The patients were
randomized into 2 groups. Group A, received continuous infusion epidural bupivacaine
0.125% 10ml/hr while, group B, received intermittent bolus epidural injection of 0.125%
bupivacaine 10ml/hr.
RESULTS: The two groups were comparable with respect to demographic
characteristics and baseline clinical variables. There was no significant difference in
postoperative pain scores (P= 0.231) during the 24 hour period. A significant difference
(P= 0.001) was found in Bromage scores between the two groups with motor weakness
noticed up to 16 hour in some patients among the continuous infusion group only.
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CONCLUSION: It is concluded that there is no significant difference in the analgesic
effect of continuous infusion epidural technique when compared to intermittent bolus
epidural technique. Patients’ satisfaction with analgesia was also comparable in both
groups.
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