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5.7 Epidural PCATwo meta-analysis have concluded that IV PCA is less effective than continuous epiduraland PCA-epidural analgesia.32, 33Local anesthetics are not widely used as the sole agent in postoperative epidural analgesia.To achieve effective analgesia using local anesthetics alone, patients will require higherconcentrations of the drugs that could result in hypotension and motor block. Nevertheless,epidural of local anesthetics alone may be warranted in situations in which the side effectsof opioids are troublesome to the patient.The most commonly used local anesthetics in epidural analgesic preparations arebupivacaine, ropivacaine and levobupivacaine. Nowadays for many clinicians ropivacaineis the local anesthetic of choice for background infusions because of their unique property ofminimum motor blockade. Most authors recommend an infusion with a 1-2% concentrationof ropivacaine at a 4-6ml/hr. An additional opioid could be used in the same mixture.
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