Comparison of levobupivacaine and levobupivacaine plus fentanyl for postoperative analgesia and hormonal response with patient controlled epidural analgesia after total knee replacement

Total-knee replacement is one of the most painful orthopedic procedures, and it is very important to provide sufficient and convenient analgesia to enhance the patient mobility and rehabilitation, and to reduce stress response to surgery during the postoperative period. Patient-controlled epidural analgesia (PCEA) is one of the most effective methods for the treatment of the post-operative pain. Levobupivacaine (L) is a local anesthetic which can be administered using the PCEA, and can be combined with fentanyl (F). In this prospective study, 40 ASA physical status I-II patients aged 50-75 yr who were scheduled to undergo total-knee replacement with combined spinal epidural anesthesia were enrolled, and randomly divided into two groups to receive L 0.125% (Group L) and L 0.125% / F 4 mcg/mL (Group F) for postoperative PCEA. After surgery, mean arterial pressures (MAP), heart rates (HR), respiratory rates (RR), pain scores at rest and movement with visual analog scale (VASR and VASM), Bromage scores biochemical test results, amount of received analgesics, side effects and the level of adrenocorticotrophic (ACTH), cortisol and prolactine in blood were compared between groups. There was no statistically significant difference between the groups in terms of MAP, HR, RR, Bromage scores, amount of received analgesics and side effects (p>0.05). Four hours after surgery, VAS pain score for Group L was significantly higher both at rest and movement (p=0.030, p=0.049) respectively. For both groups, it was noticed that the level of ACTH, cortisol and prolactine were increased after surgery and decreased, but the decreasing in Group F was statistically significant compared with Group L.It was concluded that the use of Levobupivacaine, in combination with fentanyl is much better than levobupivacaine alone for the pain relief after the total-knee replacement and for the suppression of stress response to surgery.