SummaryWe performed a randomised, double-blind study to evaluate the effect of the pre-emptive use of minimal dose intravenous fentanyl (25 lg) on the incidence of cough caused by a larger bolus of intravenous fentanyl. Six hundred patients were randomly assigned to one of three groups to receive either 0.5 ml saline 0.9% 1 min before administration of fentanyl 150 lg (3 ml), or pre-emptive fentanyl 25 lg (0.5 ml) 1 min before administration of fentanyl 125 lg or 150 lg. The incidence of fentanyl-induced cough was significantly lower in both pre-emptive groups (7 (3.5%) for 125 lg fentanyl and 15 (7.5%) for 150 lg fentanyl) than in the saline group (37 (18.5%); p = 0.001). We conclude that pre-emptive use of fentanyl 25 lg, administered 1 min before bolus injection of fentanyl (125 or 150 lg), can effectively suppress fentanyl-induced cough.

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