A comparison of pentamorphone and fentanyl in balanced anaesthesia during general surgery

The purpose of our randomized, double-blind study of 64 unpremedicated healthy patients undergoing surgical procedures with a duration of at least 60 min was to compare 0.75 μg · kg^?1 and 1 μg · kg^?1 pentamorphone with 5 μg · kg^?1 and 7.5 μg · kg^?1 fentanyl to determine which dose of opioid would reduce the requirement for isoflurane supplementation needed to maintain haemodynamic stability. At 21 points during the procedure, the haemodynamic variables of heart rate and systolic, diastolic, and mean arterial pressures were recorded. The use of isoflurane was quantified; the number of patients requiring inhaled anaesthetic, concentration peaks, MAC minutes, and duration of isoflurane use were noted. The number of equal-volume supplemental opioid analgesic doses, postoperative analgesics, occurrence of postoperative nausea, emesis, and antiemetic doses were compared. The four groups exhibited similar patient demographics, total dose of muscle relaxants, types of surgical procedures, and duration of surgery or anaesthesia. Haemodynamic variables were stable with no difference among the four study groups. The patients given pentamorphone demonstrated both delayed requirement (P < 0.05) and shorter duration (P < 0.05) of isoflurane supplementation. Patients given either 5 μg · kg^?1 or 7.5 μg · kg^?1 fentanyl needed isoflurane supplementation within 12 ± 16 min and 12 ± 17 min from induction respectively; while patients given either 0.75 μg · kg^?1 or 1 μg · kg^?1 pentamorphone did not require isoflurane supplementation for 37 ± 10 min and 43 ± 26 min respectively. In addition, the 1 μg · kg^?1 pentamorphone group had significantly (P < 0.05) lower peak isoflurane concentrations than the 5 μg · kg^?1 fentanyl study group (0.9 ± 0.5 MAC% vs 1.5 ± 0.3 MAC%). In conclusion, we found pentamorphone to be a haemodynamically stable, isofluranesparing opioid analgesic. Pentamorphone’s major advantage over fentanyl was its lower requirement for inhalation agent in a balanced anaesthesia technique.