A comparison of ®ve solutions of local anaesthetics and/or sufentanil for continuous, postoperative epidural analgesia after major urological surgery M. Hu È bler*, R. J. Litz*, K. H. Sengebusch*, I. Kreinecker*, M. D. Frank*, O. W. Hakenberg  and D. M. Albrecht* Departments of *Anaesthesiology and Intensive Care Medicine, and  Urology, University Hospital Carl-Gustav-Carus, Dresden, Germany Summary Background and objective The aim of the present study was to compare and assess the quality of analgesia, the safety and the side-effects after the use of a continuous, thoracic epidural infusion of sufen- tanil (5 lgh )1 ), 0.25% bupivacaine (10 mL h )1 ), 0.2% ropivacaine (10 mL h )1 ) alone or in combination in patients who had undergone major urological sur- gery. This prospective, randomized, double-blinded study investigated the ef®cacy of thoracic epidural infusions after major urological surgery. Methods Patients received a 72-h continuous infu- sion (10 mL h )1 ) of 0.25% bupivacaine (B), 0.2% ropivacaine (R), 0.25% bupivacaine with 0.5 lg mL )1 sufentanil (BS), 0.2% ropivacaine with 0.5 lg mL )1 sufentanil (RS) or 0.5 lg mL )1 sufentanil only (S). The analysis included 109 patients. Results The mean visual analogue scale (VAS) scores for pain were highest in the groups R and S (P < 0.001). The PaCO 2 values were signi®cantly higher in the groups RS and S (P = 0.003). Motor block occurred more frequently in the groups B and BS than in the other groups (P < 0.001). Sedation, nausea and pruritus were more common in the groups that received sufentanil. Conclusions A continuous, epidural infusion with these drugs was safe and effective in our patients. The combination of 0.2% ropivacaine plus sufentanil appeared preferable because of the low incidence of motor block. Keywords: ANALGESIA, epidural; ANAESTHETICS, LOCAL, ropivacaine, bupivacaine; OPIOIDS, sufentanil; PAIN, postoperative. Introduction Postoperative epidural analgesia can signi®cantly decrease the incidence of pulmonary morbidity [1] and is often considered the most effective technique for providing pain relief after abdominal surgery [2± 5]. Usually, a local anaesthetic is administered con- tinuously or intermittently and very often an opioid is added to the infusion to increase its analgesic effect. Lipophilic opioids are more frequently used than morphine as theoretically they offer a safer alternative for epidural administration [6]. Because their epidural effect is short, these opioids have to be administered repetitively or as a continuous infusion, which leads to cumulating plasma concentrations [7] and the risk of respiratory depression [8]. The ef®cacy of epidural analgesia depends on the site chosen for placement of the epidural catheter in relation to the surgical incision. Placement of epidural catheters in proximity to lumbar spinal segments appears to increase the risk of motor block in the lower limbs when compared with more cephalad placement [9]. The aim of the present study was to compare and assess the quality of analgesia, the safety, and the side-effects after the use of a continuous, thoracic epidural infusion of sufentanil (5 lgh )1 ), 0.25% bupi- vacaine (10 mL h )1 ), 0.2% ropivacaine (10 mL h )1 ) alone or in combination in patients who had under- gone major urological surgery. Accepted December 2000 Correspondence: M. Hu È bler. European Journal of Anaesthesiology 2001, 18, 450±457 450 Ó 2001 European Academy of Anaesthesiology