Background: Effective postoperative analgesia is essential for early mobilization, enhanced recovery, and improved patient outcomes following lower limb surgeries. Epidural administration of local anesthetics combined with opioids is widely used for postoperative pain control. Ropivacaine, with its favorable safety profile and differential sensory blockade, along with morphine, provides prolonged analgesia. However, the optimal mode of epidural drug delivery—intermittent bolus versus continuous infusion—remains unclear. Aim: To compare the efficacy and safety of epidural ropivacaine combined with morphine administered as intermittent boluses versus continuous infusion for postoperative analgesia in patients undergoing lower limb surgeries. Methods: This prospective randomized study was conducted on 30 patients (ASA I and II) undergoing elective lower limb surgeries. Patients were divided into two groups: Group IB (intermittent bolus) and Group CI (continuous infusion), with 15 patients in each group. Epidural analgesia using ropivacaine 0.1% with morphine was initiated postoperatively when the Visual Analogue Scale (VAS) score exceeded 4. Group IB received 6 mL hourly boluses, while Group CI received continuous infusion at 6 mL/hour. Pain scores (VAS), time to first rescue analgesia, total analgesic consumption, hemodynamic parameters, and adverse effects were assessed. Results: The intermittent bolus group demonstrated significantly lower VAS scores at 12 and 24 hours compared to the continuous infusion group (p < 0.05). Time to first rescue analgesia was significantly prolonged in Group IB, with reduced total analgesic consumption. Hemodynamic parameters remained stable and comparable in both groups. The incidence of adverse effects was low and similar between groups, with no serious complications observed. Conclusion: Intermittent epidural bolus administration of ropivacaine with morphine provides superior postoperative analgesia compared to continuous infusion, with prolonged pain relief and reduced drug consumption, without compromising safety. This technique may be preferred for postoperative pain management in lower limb surgeries.

Epidural analgesia, Ropivacaine, Morphine, Intermittent bolus, Continuous infusion, Postoperative pain, Lower limb surgery.