Article Text

Download PDFPDF
Postoperative Epidural Analgesia After Total Knee Arthroplasty With Sufentanil 1 μg/mL Combined With Ropivacaine 0.2%, Ropivacaine 0.125%, or Levobupivacaine 0.125%: A Randomized, Double-Blind Comparison
  1. Elske Sitsen, M.D.,
  2. Frans van Poorten, M.D.,
  3. Wim van Alphen, M.D.,
  4. Lili Rose, M.D.,
  5. Albert Dahan, M.D., Ph.D. and
  6. Rudolf Stienstra, M.D., Ph.D.
  1. Department of Anesthesiology, Leiden University Medical Center, Leiden
  2. Department of Anesthesiology, Reinier de Graaf Gasthuis, Delft, The Netherlands
  1. Reprint requests: Elske Sitsen, M.D., Department of Anesthesiology P5-Q, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands. E-mail: mesitsen{at}


Background and Objectives: Total knee replacement is associated with severe postoperative pain that, if treated insufficiently, interferes with early rehabilitation. The purpose of the present study is to compare the efficacy of ropivacaine (0.2% and 0.125%) and levobupivacaine (0.125%), all in combination with sufentanil 1 μg/mL with regard to postoperative pain relief and absence of motor block in a patient-controlled epidural analgesia setting.

Methods: The study design was randomized and double-blind. Sixty-three patients scheduled for total knee replacement under combined spinal-epidural anesthesia were randomly allocated to receive ropivacaine 0.2%/sufentanil 1 μg/mL (group 1), ropivacaine 0.125%/sufentanil 1 μg/mL (group 2), or levobupivacaine 0.125%/sufentanil 1 μg/mL (group 3) for postoperative epidural pain relief.

Primary endpoints were numerical rating scores for pain and patient satisfaction, motor block scores, time to first demand of the patient-controlled epidural analgesia device and average hourly consumption of local anesthetic and sufentanil.

Results: There were no significant differences between the 3 groups regarding numerical rating scores for pain, patient satisfaction, and motor block scores at any of the time intervals; time to first demand and average hourly sufentanil consumption were similar. Patients in group 1 used significantly more local anesthetic than patients in groups 2 and 3.

Conclusions: All 3 solutions provided adequate analgesia and minimal motor block. The higher concentration of ropivacaine 0.2% was associated with a higher consumption of local anesthetic and did not result in a decrease in the consumption of sufentanil. Under the conditions of this study, patient-controlled epidural analgesia consumption of the epidural mixture was predominantly determined by sufentanil.

  • PCEA
  • Ropivacaine
  • Levobupivacaine
  • Epidural
  • Randomized double-blind trial
  • Analgesia

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • The results of this study were presented in part at the 32nd Annual Regional Anesthesia Meeting of the American Society of Regional Anesthesia and Pain Medicine in Vancouver, Canada, April 19-22, 2007.