Continuous epidural infusion of fentanyl for postoperative analgesia

Abstract

Summary A continuous epidural infusion offentanyl was used,for c,ontrol o f postoperatitle pain in a seriesThe identification of endogenous morphine-like peptides' and the identification and localisation of specific receptor sites in the central nervous system for these peptides and opiate analgesic^,"^ led to investigations by Yaksh and fellow workers in animals,"x and Wang and colleagues in human^,^ of the analgesic effects of low doses of opiates introducted into the subarachnoid space. Behar and othersI0 subsequently demonstrated Forum 1003 that morphine introduced into the epidural space could also confer considerable relief in chronic pain. Further reports using pethidine, phenoperidine, and fentanyl,"-I3 and also diamorphine by one of the authors (unpublished data) have demonstrated varying analgesic response in various special situations. Recently, control of postoperative pain for 6 hours or more has been reported with bolus doses of epidural r n~r p h i n e . '~ The authors have studied the feasibility of a method of epidural infusion of opiate (fentanyl) to provide postoperative analgesia on routine operating lists, in the environment of a general surgical ward. Puiieni seleciion and meihodsPatients undergoing general surgical procedures were studied in whom conventional local anaesthetic epidural techniques were used, either as the sole anaesthetic or together with light general anaesthesia. Consent for the postoperative procedure was obtained from the patients following pre-anaesthetic discussion. Operations performed were Caesarean section, pyeloplasty, abdominal hysterectomy, hip prosthesis ( 1 case each), cholecystectomy, herniorrhaphy (3 cases each), prostatectomy and large bowel surgery (10 cases each). Patients' ages ranged from 25 to 86 years.After the epidural space had been located, a catheter was introduced and left in siiu. A bacterial filter was attached to the catheter and all drugs were given through this filter. The L1/2 or L2/3 interspaces were used for lower abdominal operations, and the T6/7 interspace for upper abdominal operations.At the completion of the operative procedure, an infusion of fentanyl was started. Initially (first 20 patients), this consisted of a solution of 5 p g of fentanyl/ml, prepared by diluting 10 ml of the commercial solution to 100 ml with normal saline or Ringer lactate (BPC) solution in a paediatric type microdrop administration set. The rate of infusion was regulated either manually or by an infusion controller (Ivac series) to deliver between 4 and 10 ml per hour according to the anticipated analgesic requirements. This delivered fentanyl to the patients at approximately 0.5 pg/kg/hour. In a further 10 patients the strength of the fentanyl solution was reduced to 2.5 &ml. The method was otherwise identical, but fentanyl was delivered at only 0.25 pg/kg/hour. The burette was recharged with fentanyl solution as it became empty.The patients under study were also prescribed intramuscular analgesics for use if necessary should there be inadequate pain relie...

Epidural fentanyl and sufentanil for intra- and postoperative analgesia

“…Bailey and Smith observed nausea in 9 of 20 patients with 50/~g/h fentanyl. With a lower dose of 25/xg/h fentanyl no troublesome nausea occurred ~" [16]. These findings were confirmed in another study E~ [13].…”

Postoperative extradural analgesia in children: comparison of morphine with fentanyl †

“…The onset of analgesia is quicker than with morphine (around 13 min) [4], but the duration of action of a single dose is shorter (6 h) and there is a need for a continuous infusion. Satisfactory analgesia has been provided in adults by continuous extradural infusion of fentanyl [5]. Because fentanyl has not been assessed extensively in children [6,7], we have compared the efficacy and side effects of equipotent doses [8] of extradural morphine and fentanyl for postoperative analgesia in children.…”

Respiratory effects of epidural fentanyl

“…Following the continuous infusion of epidural fentanyl we could not detect any significant changes in either of the measurements for up to 18 hours, despite a rising trend in the plasma fentanyl concentration. The increasing plasma fentanyl concentration during epidural infusion could be the result of cumulation, although this is most unlikely with the fentanyl dose used in this study.…”