Comparison of standing stability with different doses in epidural fentanyl among post-cesarean delivery women: a prospective trial

Abstract

Background: The study purpose was to determine the safety and efficacy of different doses of epidural fentanyl plus local anesthetics on ambulation for patients who had elective cesarean delivery. Methods: A prospective study at a single community hospital used posturography to compute Sway area for assessment of standing stability [ISRCTN14517337]. Continuous epidural infusion of 0.2% ropivacaine containing either 2.5 mcg.mL-1 (Group 1, n = 8) or 5 mcg.mL-1 fentanyl (Group 2, n = 8) was randomly assigned to an individual and started at a rate of 5 mL.h-1 postoperatively and continued for 48 hours after cesarean delivery in addition to standing acetaminophen and ibuprofen. Posturography measured with SYMPACK™ was used to compute Sway area for investigation of standing stability. The unpaired t-test was used to compare continuous variables between groups. Analysis of variance (ANOVA) was used to assess differences of Sway area measured repeatedly within groups. Results: Participants’ demographics, pain status, and leg motor function one day after cesarean delivery were not different between groups. Sway area in Group 1 was not different across three repeated measurements. Sway area of Group 2 on postoperative day 1, with epidural analgesia, was significantly higher than at the baseline (4.1 ± 2.8 vs. 3.1 ± 1.1 cm2, p < 0.05). Conclusions: Because both low and high concentrations of epidural fentanyl allowed participants to ambulate with the same pain effect, the lower concentration of continuous epidural fentanyl (2.5 mcg.mL-1 at 5 mL.h-1) is warranted to avoid potential adverse events during ambulation after cesarean delivery.

Keywords

• Cesarean section
• Analgesia
• Epidural
• Standing position
• Postural balance
• Early ambulation