RESUMO
The study was undertaken to evaluate the effectiveness and safety of ropivacaine used via long-term epidural infusion and to define the optimum doses of the agent in the intra- and postoperative period. The parameters of hemodynamics, the adequacy of anesthesia, and the consumption of the agent were explored in 53 patients (ASA III-IV) aged 68 +/- 1.4 years operated on for abdominal cancer. Following 15 and 25 min of the injection of a bolus dose of ropivacaine, the occurrence of sensory block II was observed in 60 and 95% of the patients, respectively. After injection of ropivacaine in a bolus dose (56 +/- 3.4 mg), there was a 20% lowering of mean blood pressure and a 17% reduction in heart rate as compared with the baseline values. Maintenance infusion was made at a rate of 15-25 (20 +/- 1.9) mg/h. The total consumption was 126 +/- 13 mg. Bradycardia was noted in 4 (7.5%) cases; 7 (13%) patients required additional administration of phentanyl. The latter was used in a dose of 100 microg in 87% of the patients only prior to tracheal intubation. For postoperative analgesia, 0.2% ropivacaine was infused at a rate of 6-10 ml/h. Increasing its dose up to 12-14 ml/h resulted in hypotension and the occurrence of the signs of motor block. Postoperative analgesia was effective in 89% of cases when the agent was infused at rate of 8.8 +/- 0.9 ml/h and the hemodynamic parameters were stable. Postoperative intestinal paresis was abolished in 85.8% of patients after an average of 52 +/- 2.7 hours. Long-term epidural infusion of ropivacaine may be regarded as an effective component of anesthesia at abdominal surgery in elderly patients with severe comorbidity. The method allows one to completely refuse the use of narcotic analgesics in most cases both during a surgical intervention and in the postoperative period, which creates good conditions for an early activation of patients and for a reduction of postoperative complications.