A Randomized Double-blind Comparison of Epidural versus Intravenous Fentanyl Infusion for Analgesia after Thoracotomy

Salomäki, Timo; Laitinen, J; Nuutinen, L

doi:10.1097/00000542-199111000-00010

Cited by 189 publications

(74 citation statements)

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“…Nausea or vomiting is a typical side effect of opiates by any route but is also associated with surgery and anesthesia in general, with great variability in reported incidences; the rates of 20% with fentanyl and 14% with sufentanil 18,19 are very similar to those we found with the continuous infusion of methadone. Hypoventilation (36.7% in the MB group vs 20% in the MCI group) and bradypnea (10% in the MB group vs 5% in the MCI group) were similar in our study in both groups.…”

Section: Discussionsupporting

confidence: 78%

“…The reported incidence of bradypnea with epidural fentanyl is 15%, 1 9 and the incidence of hypoventilation with epidural fentanyl is 10 to 25%. 8,19 Reported rates are greater than those we found with the continuous infusion of methadone. Arterial oxygen desaturation was assessed in the first 24 postoperative hours while oxygen was supplied.…”

Section: Discussionmentioning

confidence: 58%

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Continuous epidural infusion of racemic methadone results in effective postoperative analgesia and low plasma concentrations

Prieto-Alvarez

Tello-Galindo

Cuenca-Peña

et al. 2002

Can J Anesth/J Can Anesth

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Purpose: To compare two protocols of epidural administration of racemic methadone for postoperative analgesia (continuous infusion and intermittent bolus), focussing on plasma concentration, analgesic efficacy and side effects.Methods: Ninety patients undergoing abdominal or lower-limb surgery were randomly assigned to two groups in a prospective double-blind design. The continuous infusion patients ( n=60) received initial doses of 3 to 6 mg followed by 6 to 12 mg by continuous infusion over 24 hr. The bolus administration patients (n=30) received repeated boluses of 3 to 6 mg of racemic methadone every eight hours. Pain intensity was assessed on a visual analog scale. Amount of supplementary analgesia was recorded, as was the incidence of side effects. Plasma methadone concentrations were determined by high performance liquid chromatography. Treatment was continued for 72 hr.Results: Pain relief was good and comparable in both groups throughout the three days of treatment. No accumulation of plasma racemic methadone was observed in either group, although the concentrations were significantly higher in the bolus group. Miosis was significantly more frequent in the bolus group.Conclusion: Plasma methadone concentrations were significantly lower with continuous infusion. Plasma methadone accumulation, which is considered the main disadvantage for its purported influence on the incidence of side effects, did not occur at the doses used over the three days of treatment that we report.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 58%

Continuous epidural infusion of racemic methadone results in effective postoperative analgesia and low plasma concentrations

Prieto-Alvarez

Tello-Galindo

Cuenca-Peña

et al. 2002

Can J Anesth/J Can Anesth

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“…3,11,15,21 Some investigators found that the plasma concentration of fentanyl was much lower after epidural injection than after intravenous administration. 12,16 In the present study, only two patients in group 1 and one patient in group 2 presented a fentanyl concentration of 0.63 ng/ml during the period analyzed.…”

Section: Discussionmentioning

confidence: 45%

“…Several investigators [7][8][9][10][11][12][13][14][15][16][17][18][19][20] have evaluated the mechanism of action of fentanyl administered epidurally. Although many studies 3,9-12,15,17 have concluded that the mechanism of action is associated with systemic absorption of the opioid into the circulation, followed by a supraspinal effect, many investigators continue to use fentanyl as a continuous infusion.…”

Section: Discussionmentioning

confidence: 99%

Epidural versus intravenous fentanyl for postoperative analgesia following orthopedic surgery: randomized controlled trial

et al. 2010

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CONTEXT AND OBJECTIVE: Controversy exists regarding the site of action of fentanyl after epidural injection. The objective of this investigation was to compare the efficacy of epidural and intravenous fentanyl for orthopedic surgery. DESIGN AND SETTING:A randomized double-blind study was performed in Hospital São Paulo. METHODS:During the postoperative period, in the presence of pain, 29 patients were divided into two groups: group 1 (n = 14) received 100 µg of fentanyl epidurally and 2 ml of saline intravenously; group 2 (n = 15) received 5 ml of saline epidurally and 100 µg of fentanyl intravenously. The analgesic supplementation consisted of 40 mg of tenoxicam intravenously and, if necessary, 5 ml of 0.25% bupivacaine epidurally. Pain intensity was evaluated on a numerical scale and plasma concentrations of fentanyl were measured simultaneously. RESULTS:The percentage of patients who required supplementary analgesia with tenoxicam was lower in group 1 (71.4%) than in group 2 (100%): 95% confidence interval (CI) = 0.001-0.4360 (P = 0.001, Fisher's exact test; relative risk, RR = 0.07). Epidural bupivacaine supplementation was also lower in group 1 (14.3%) than in group 2 (53.3%): 95% CI = 0.06-1.05 (P = 0.03, Fisher's exact test; RR = 0.26). There was no difference in pain intensity on the numerical scale. Mean fentanyl plasma concentrations were similar in the two groups.CONCLUSION: Intravenous and epidural fentanyl appear to have similar efficacy for reducing pain according to the numerical scale, but supplementary analgesia was needed less frequently when epidural fentanyl was used. CLINICAL TRIAL REGISTRATION NUMBER: NCT00635986RESUMO CONTEXTO E OBJETIVO: Existem controvérsias sobre o local de ação do fentanil injetado por via peridural. O objetivo foi comparar a eficácia do fentanil peridural e do venoso em cirurgias ortopédicas. TIPO DE ESTUDO E LOCAL:Estudo aleatório, duplo-cego, realizado no Hospital São Paulo. MÉTODO:No pós-operatório, na presença de dor, 29 pacientes foram divididos em dois grupos: grupo 1 (n = 14) recebeu solução de 100 mcg de fentanil por via peridural e 2 ml de solução salina venosa; grupo 2 (n = 15), 5 ml de solução salina peridural e 100 µg de fentanil venoso. A complementação analgésica foi com 40 mg de tenoxicam venoso e, se necessário, 5 ml de bupivacaína 0.25%. A intensidade da dor foi avaliada pela escala numérica e a concentração plasmática do fentanil foi medida simultaneamente.RESULTADOS: A percentagem de pacientes que necessitaram de complementação analgésica com tenoxicam foi menor no grupo 1 (71.4% versus 100.0% grupo 2): intervalo de confiança, IC 95% = 0.001-0.4360 (P = 0.001, teste exato de Fisher; risco relativo, RR = 0.07). A complementação com bupivacaína peridural também foi menor no grupo 1 (14.3% versus 53.3% grupo 2): IC 95% = 0.06-1.05 (P = 0.03, teste exato de Fisher; RR = 0.26).Não houve diferença na intensidade da dor avaliada pela escala numérica. As concentrações plasmáticas do fentanil foram semelhantes nos dois grupos.CONCLUSÃO: A eficácia do...

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“…Every report of continuous epidural fentanyl analgesia in which plasma levels were measured demonstrated concentrations equal to or greater than the MEC for PCA-/v fentanyl following abdominal surgery. 3,6,11,21 Many of the conflicting findings reported by investigators comparing epidural with intravenous fentanyl following thoracotomy, all of which involved infusion techniques, can be explained by differences in experimental design. Only those studies in which fentanyl was given on a PCA basis or where the protocol ensured that the minimum effective infusion rates were achieved have doc-umented a drug-sparing effect for the epidural route.…”

Section: Epidural Opioids For Post-thoracotomy Painmentioning

confidence: 99%

Epidural opioids for post-thoracotomy pain

Grant

1994

Can J Anaesth

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A Randomized Double-blind Comparison of Epidural versus Intravenous Fentanyl Infusion for Analgesia after Thoracotomy

Cited by 189 publications

References 0 publications

Continuous epidural infusion of racemic methadone results in effective postoperative analgesia and low plasma concentrations

Continuous epidural infusion of racemic methadone results in effective postoperative analgesia and low plasma concentrations

Epidural versus intravenous fentanyl for postoperative analgesia following orthopedic surgery: randomized controlled trial

Epidural opioids for post-thoracotomy pain

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