Postoperative analgesia with epidural fentanyl.

A retrospective analysis of 133 patients who received continuous epidural fentanyl for postoperative analgesia is presented. Using a concentration of 5 micrograms/mL of fentanyl, patients received continuous epidural infusions for 24 to 72 hours postoperatively. The average rate of infusion was 60 micrograms/h. A total of 59.3% of the patients received no additional narcotics; 26.3% required supplemental narcotics during the first 24 hours only. Three percent had the infusion discontinued because it provided poor pain control. Side effects were less than, or comparable to, those of epidural morphine. Respiratory depression, defined as a respiratory rate of less than 8, or apnea did not occur. Urinary retention occurred in one patient. Pruritus occurred in 4% (6 patients). Nausea occurred in 25.5%, a rate comparable to that which occurred with epidural morphine. No side effects occurred in 70.6% of the patients reviewed. These data show that epidural fentanyl provides good to excellent pain relief with minimal side effects.     

Postoperative analgesia after total hip arthroplasty: patient-controlled analgesia versus transdermal fentanyl patch

STUDY OBJECTIVE: To determine whether a new transdermal fentanyl patch (TFP) is a good choice for the postoperative pain management of patients undergoing primary total hip arthroplasty compared with patient-controlled analgesia (PCA). DESIGN: Randomized, prospective study. SETTING: University hospital. PATIENTS: 30 patients undergoing primary total hip arthroplasty. INTERVENTIONS: Patients received either a TFP (group T; Duragesic 50 microg/h, matrix fentanyl patch, Janssen-Cilag) applied approximately 10 hours before induction of general anesthesia and PCA programmed in the postanesthesia care unit (PACU), or PCA programmed in the PACU (group P). MEASUREMENTS: Intraoperative sufentanil and additional postoperative morphine administration were recorded, as well as visual analog scores and routine vital signs at predetermined intervals during the first 48 hours. MAIN RESULTS: Morphine consumption on arrival in the PACU was 3.5+/-3 mg in group T versus 13+/-5 mg in group P (P<0.0001). Visual analog scores on arrival in the PACU were 37+/-22 mm in group T versus 73+/-13 mm in group P (P<0.0001). Cumulative morphine consumption at the 24th hour was 43+/-16 mg in group P and 4+/-3 mg in group T (P<0.0001). Cumulative morphine consumption at the 48th hour was 54+/-26 mg in group P and 5+/-4 mg in group T (P<0.0001). Intraoperative sufentanil consumption was 38+/-15 microg in group T versus 30+/-5 microg in group P (not significant). The sedation score was 0 in both groups during the first 48 postoperative hours. CONCLUSIONS: Preoperative TFP application decreases pain scores and morphine consumption in the PACU and appears to have prolonged effects spanning the first 48 postoperative hours.     

Efficacy of epidural dexamethasone versus fentanyl on postoperative analgesia

Purpose  

Dexamethasone has analgesic, anti-inflammatory, and antiemetic effects. This prospective, randomized, double-blind, controlled study was designed to evaluate the efficacy of adding dexamethasone versus fentanyl to epidural bupivacaine on postoperative analgesia.     

Diclofenac sodium versus fentanyl for analgesia in laparoscopic sterilization

The effectiveness of an anaesthetic technique employing diclofenac sodium as an analgesic given preoperativey by intramuscular injection was compared against one employing intravenous fentanyl in patients undergoing laparoscopic sterilization. Postoperative pain was marked and both drugs provided partial relief only. Patients in the diclofenac group had pain scores that were initially higher than those in the fentanyl group and the difference between the groups was statistically significant ( P < 0.02). Patients in the diclofenac group who received postoperative supplemental morphine analgesia recorded lower pain scores at 30 min than comparable patients in the fentanyl group ( P < 0.03). These findings suggest that neither drug provides sufficient analgesia for laparoscopic sterilization when given as a sole analgesic. Investigation of a combined analgesic technique employing morphine and a non–steroidal anti–inflammatory drug is warranted.     

A randomized double-blind comparison of epidural versus intravenous fentanyl infusion for analgesia after thoracotomy

This study compared epidural and intravenous fentanyl infusions for pain relief for the first 20 h after thoracotomy, in order to examine whether an thoracic epidural fentanyl infusion offers clinical advantage over an intravenous infusion. Forty patients were assigned randomly to receive either fentanyl epidurally and saline intravenously or fentanyl intravenously and saline epidurally in a double-blind fashion. For each patient the fentanyl infusion was titrated to a rate required for pain relief (pain score less than 3, maximum 10). Patients reported similar median pain scores, but in the epidural group the required mean fentanyl infusion rate was less (0.95 +/- 0.23 vs. 1.67 +/- 0.46 micrograms.kg-1.h-1, P = 0.0001) and plasma fentanyl concentrations were less at 4 and 18 h (4 h: 0.81 +/- 0.27 vs. 1.38 +/- 0.36 ng.ml-1, P = 0.0001; 18 h: 0.94 +/- 0.32 vs. 1.54 +/- 0.65 ng.ml-1, P = 0.0007) than those in the intravenous group. Respiratory function was better preserved and the incidence of nausea and sedation was less in the epidural group than in the intravenous group. In conclusion there appears to be a clinical advantage to the epidural infusion over the intravenous infusion of fentanyl for analgesia after thoracotomy.     

Patient-controlled epidural analgesia versus continuous epidural analgesia after total knee arthroplasty

BACKGROUND: Patient-controlled epidural analgesia (PCEA) has been found to be an effective method for pain relief during labour and after surgery. The goal of this study was to compare the efficacy of bupivacaine-fentanyl PCEA and continuous epidural infusion with the same mixture for treatment of pain after total knee arthroplasty. METHODS: Fifty-four patients under spinal anaesthesia were allocated to two groups in this randomized, double-blind study: the PCEA group could demand a bolus of 0.05 ml/kg of the bupivacaine 1.1 mg/ml and fentanyl 5 microg/ml solution, with a lockout interval of 10 min and total dose limit of three bolus doses per hour. The EPI group received a continuous infusion of 0.1 ml kg(-1) h(-1) of the same bupivacaine-fentanyl solution, and only a minimal extra bolus dose of 0.2 ml with the same lockout interval. All the patients received also paracetamol 1 g, orally, three times a day. In addition to pain scores at rest and during leg lifting, the 20-h analgesic consumption and the incidence of side effects were recorded. RESULTS: Forty-nine patients completed the study. The bupivacaine and fentanyl consumption during 20 h was smaller in the PCEA group (P<0.001). Analgesia and the need for rescue-opioid medication were similar in both groups. There were no differences between the PCEA and EPI groups regarding the incidence of side effects. Five patients were confused about how to operate the PCEA apparatus. CONCLUSION: The amount of bupivacaine-fentanyl solution consumed was significantly less with PCEA than with continuous infusion of bupivacaine-fentanyl solution without affecting the quality of postoperative analgesia after total knee arthroplasty. Several of the elderly patients had difficulties in operating the PCEA apparatus.     

Comparison of maternal and neonatal outcomes with epidural bupivacaine plus fentanyl and ropivacaine plus fentanyl for labor analgesia

BACKGROUND: Several studies have been performed to find a safe method of labor analgesia with minimal side effects and toxicity in mother and fetus. We aimed to compare the efficacy and side effects of epidural bupivacaine plus fentanyl and ropivacaine plus fentanyl at low concentrations. METHOD: Forty ASA I-II parturients' were included in this prospective, double-blind, trial and randomized to receive either bupivacaine or ropivacaine for labor analgesia. Analgesia was initiated with 8 mL of 0.125% solution plus fentanyl 50 microg and maintained with a continuous infusion of 0.0625% solution with fentanyl 2 microg/mL. RESULTS: There were no differences in pain scores, total dose of local anesthetics used, sensory or motor blockade, labor duration, mode of delivery, side effects, patient satisfaction, or neonatal outcome between the two local anesthetics at these dosages, but at the end of the second stage and delivery, adequate analgesia quality could not be ensured. CONCLUSION: We found no major advantage of continuous epidural infusion of ropivacaine 0.0625% plus fentanyl 2 microg/mL over bupivacaine 0.0625% plus fentanyl 2 microg/mL for labor analgesia. We believe that different methods or dosages may be tried in order to improve comfort at the second stage of labor and the delivery.     

Postoperative nausea and vomiting after laparoscopic cholecystectomy under total intravenous anesthesia using propofol combined with fentanyl or pentazocine

BACKGROUND: The aim of this study was to compare the incidence of postoperative nausea and vomiting (PONV) in propofol-anesthetized patients receiving either fentanyl or pentazocine as opioid supplement. METHODS: Sixty-seven patients scheduled for laparoscopic cholecystectomy were analyzed retrospectively. Patients were classified into two groups according to opioid supplement under propofol-anesthesia; pentazocine group (n = 26) and fentanyl group (n = 41). Anesthesia was induced with propofol using target controlled infusion method, and was maintained with propofol infusion with pentazocine or fentanyl and intermittent administration of vecuronium with 40% oxygen in air. RESULTS: The incidence of PONV was 23.1% in fentanyl group and 22.0% in pentazocine group, respectively. The incidence of PONV was not different between the groups. There were no severe complications. CONCLUSIONS: The incidence of PONV in propofol-anesthetized patients receiving pentazocine as opioid supplement is not different from that in patients receiving fentanyl.     

罗哌卡因复合芬太尼用于胸科患者术后硬膜外镇痛

目的 评估罗哌卡因复合不同浓度芬太尼用于胸科手术后硬膜外镇痛(PCEA)效果及不良反应.方法 选取择期胸科食管及贲门手术男性患昔72例,年龄18～65岁,随机分成三组,每组24例.术前T7～8行硬膜外穿刺留置导管,术后接硬膜外镇痛泵.分别用罗哌卡因复合芬太尼1μg/ml(A组)、2μg/ml(B组)或3μg/ml(C组),观察术后2、4、8、12、24、36、48 h的安静/咳嗽疼痛VAS评分、不良反应和追加使用吗啡剂量和PCEA按压情况.结果 术后2、4、8 h,B、C组安静和咳嗽时VAS评分均明显低于A组(P＜0.05);术后16 h,B、C组咳嗽时VAS评分仍低于A组(P＜0.05).B、C组PCEA按压次数显著少于A组(P＜0.01),追加吗啡量也明显低于A组(P＜0.01).结论 0.15%罗哌卡因合用1、2、3μg/ml芬太尼用于PCEA均可获得满意镇痛效果;但推荐以0.15%罗哌卡因合用2μg/ml为首选,镇痛效果好,不良反应低.     

Postoperative analgesia with intravenous fentanyl PCA vs epidural block after thoracoscopic pectus excavatum repair in children

Background: The aim of this prospective, randomized trial was to compareanalgesia, sedation, and cardiorespiratory function in childrenafter thoracoscopic surgery for pectus excavatum repair, usingtwo types of analgesia—epidural block with bupivacaineplus fentanyl vs patient-controlled analgesia (PCA) with fentanyl. Methods: Twenty-eight patients scheduled for thoracoscopic pectus excavatumsurgery were randomly assigned to receive either thoracic epiduralblock or i.v. PCA for postoperative analgesia. Pain was assessedusing a visual-analogue scale (VAS). The Ramsay sedation score,arterial pressure, ventilatory frequency, and heart rate werealso measured, and blood gas analysis was performed regularlyduring the first 48 h after surgery. Results: A significant decrease in the VAS pain score, Ramsay sedationscore, heart rate ventilatory frequency, systolic and diastolicblood pressure, and Pa_CO2, and a significant increase in Pa_O2and oxygen saturation were found over time. Patients in thePCA group had significantly higher Pa_CO2 values. In addition,a significantly slower decline of systolic blood pressure andheart rate, and faster recovery of Pa_CO2 were found in PCA patientsthan in patients with epidural block. Conclusions: I.V. fentanyl PCA is as effective as thoracic epidural for postoperativeanalgesia in children after thoracoscopic pectus excavatum repair.Bearing in mind the possible complications of epidural catheterizationin children, the use of fentanyl PCA is recommended.     

Prospective evaluation of laparoscopic colon resection versus open colon resection for adenocarcinoma

Laparoscopic colon resection (LCR) has been performed in the United States sine 1990. This procedure has been accepted by many as a reasonable alternative for nonmalignant, colonic, surgical disease, but the laparoscopic approach remains controversial for curative treatment of carcinoma. In this paper, the results of a nonrandomized series of two large experiences of laparoscopic colon resections were performed and followed for 3 1/2 years in a prospective fashion against an equal number of patients who underwent open resection. The setting was several large metropolitan hospitals in San Antonio, Texas. Over 194 patients were involved in this study. Each patient once diagnosed with resectable colonic cancer was allowed to choose their own procedure, laparoscopic or open colon resection, either of which was performed by the authors. Factors considered include age, sex, body habitus, stage of cancer, margins of resection, numbers of lymph nodes retrieved, hospitalization time, and follow-up period. Observations at this time indicate the following: (1) LCR allows for resection comparable to the classical approach, (2) equal numbers of mesenteric lymph nodes can be retrieved, (3) adequacy of margins of resection can be accurately determined by colonoscopy during LCR, and (4) brief follow-up periods show comparable survival and disease-free intervals. It is the conclusion of the authors that with proper training LCR will come to be recognized as a safe, effective surgical option for treatment of selected patients with colon cancer.     

A randomized double-blind comparison of epidural versus intravenous fentanyl infusion for analgesia after cesarean section

The authors conducted a randomized double-blind controlled study comparing groups of patients receiving iv or epidural fentanyl infusions to determine whether, at comparable levels of analgesia, 1) the severity of side effects was different; and 2) plasma fentanyl concentrations differed between the two groups. Twenty-eight ASA physical status 2 women scheduled to undergo elective cesarean section were randomized into two groups to either receive fentanyl intravenously and saline epidurally or fentanyl epidurally and saline intravenously. After delivery of the infants under epidural anesthesia, each patient received a bolus of fentanyl 1.5 microgram/kg either intravenously or epidurally, and a fentanyl infusion was begun via the same route. Concurrently, a saline bolus and infusion were given via the alternate route. The rates of the fentanyl and saline infusions were adjusted until each patient was comfortable. Patients rated their pain, nausea, and pruritus on visual analogue scales. Sedation was evaluated by an observer. Respiratory depression was evaluated by end-tidal PCO2. Data were analyzed by unpaired two-tail t tests. Plasma fentanyl concentrations were measured at 12 and 24 h. Three patients in the iv group were dropped from the study because of inadequate pain relief. For the remaining 25 patients, similar infusion rates of fentanyl were required to produce similar levels of analgesia at 12 and 24 h. The severity of nausea, pruritus and sedation, and end-tidal PCO2 were similar for both groups. The plasma concentrations of fentanyl were significantly greater in those who received iv fentanyl at 12 h but not at 24 h.(ABSTRACT TRUNCATED AT 250 WORDS)     

Postoperative analgesia by epidural methylprednisolone after posterolateral thoracotomy

The aim of this study was to evaluate the potential analgesiceffect of epidural methylprednisolone (MP) after posterolateralthoracotomy (PLT). Adult male patients undergoing PLT for lungsurgery were included in a prospective, randomized, double blindstudy. Peroperative analgesia (bupivacaine plus sufentanil)was given by a thoracic epidural catheter associated with generalanaesthesia. After surgery, patients received either MP 1 mgkg^–1 followed by a continuous epidural infusion of MP1.5 mg kg^–1 during 48 h (MP group) or 0.9% saline as abolus injection and continuous epidural infusion (P group).Additional morphine analgesia was administered by i.v. patient-controlledanalgesia. Pain was assessed at rest and with mobilization every4 h after operation during 48 h with a visual analogue scale(VAS). The primary end-point was the total morphine requirementsduring the 48 first postoperative hour. Twenty-four patientswere allocated to MP (n=12) and P (n=12) groups. Characteristicsof the two groups were similar. There were no differences betweengroups for morphine requirements (median and interquartile range)during the 48 h: 59 mg (40–78) in MP group vs 65 mg (59–93)in P group. There were no differences between groups for morphinerequirements every 4 h during the 48 h and VAS for pain at restand evoked pain. No side effects were reported. It was concludedin this small study that these results did not support the useof epidural steroids for postoperative analgesia after PLT. Br J Anaesth 2001; 87: 635–8