Comparisons of two different doses of fentanyl for procedural analgesia during epidural catheter placement: a double-blind prospective, randomized, placebo-controlled study

Abstract

The purpose of this study was to investigate the effect of fentanyl on analgesic properties and respiratory responses during an epidural procedure. Sixty patients premedicated with oral brotizolam 0.25 mg were allocated to receive procedural analgesia with saline or 25 or 50 μg of fentanyl. Five minutes after administration, an epidural procedure was started. Pain assessments were made immediately after the epidural catheter placement using a visual analog scale. The lowest SpO₂ levels during the procedure were recorded to evaluate respiratory depression, and cardiovascular complications were also recorded. The pain scores were significantly lower in the 25 and 50 μg fentanyl groups than in the placebo group (P < 0.01). There was no difference in pain assessment between the 25 and 50 μg fentanyl groups. The lowest SpO₂ value of the 50 μg fentanyl group was significantly lower than those of the other groups (P < 0.001). Seven of 20 cases in the 50 μg fentanyl group needed oxygen administration because of a decreased SpO₂ value (<94%). No cardiovascular complications were observed in any group during the entire study period. Thus, intravenous fentanyl at a dose of 25 μg provides effective procedural analgesia without the risk of hypoxemia during an epidural procedure in a patient with preanesthetic medication.

Comparison of Predicted and Perceived Pain from Epidural and Spinal Puncture in Patients Undergoing Elective Caesarean Section

“…We reported similar results for pain experienced from epidural puncture (35 mm) in non-pregnant Japanese-speaking patients undergoing elective surgery 18 . A score of 62 mm was reported among patients having epidural puncture for chronic nonmalignant pain therapy 19 .…”

Procedural Aspects of Epidural Catheter Placement: A Prospective Observational Study of 173 Epidural Catheter Insertions

“…When categorized into pain groups 3,4 , actual pain associated with the procedure was reported as no/mild pain in most patients (58%), moderate pain in 38% of the patients, and severe pain in only 4% of the patients. We showed that the use of procedural medication in our study had only a minor influence on experienced pain, and the observed levels were comparable to those observed for the EDC procedure [5][6][7] . We also found that patients expected the procedure to be significantly more painful than they subsequently experienced.…”

The Effect of Preprocedural Low-Dose Ketamine for Pain and Anxiety in Patients during Thoracic Epidural Catheterization

“…Even a comprehensive preoperative interview and explanations about the TEC procedure may not always be sufficient to cope with this anxiety and fear. Anesthesiologists can sometimes overlook the anxiety and fear of the patients about the possible complications of the procedure [3]. Although there are many studies and meta-analyses on the consumption of intravenous ketamine in low doses as an intraoperative anesthetic and postoperative analgesia [19,20], there are only a few studies on pain and anxiety during TEC [2,3,5].…”

“…This unfavorable experience may adversely affect the process by causing an increase in anxiety and pain [2]. Several sedative agents are used to reduce pain and anxiety before painful procedures [3,4]. While there are some studies aimed at reducing pain and anxiety during spinal anesthesia and lumbar epidural block applications, studies on TEC are limited [3,5].…”