Dose effects of alfentanil in human analgesia

Hill, Harlan F.; Walter, Max; Saeger, Louis C.; Sargur, Mukund; Sizemore, William; Chapman, C. Richard

doi:10.1038/clpt.1986.161

Cited by 17 publications

(5 citation statements)

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“…The results of the present study support the hypothesis The analgesic effects of alfentanil in awake subjects are dose-related (Hill et al 1986). The mean minimum effec- tive analgesic plasma concentration in the eady postoperative period has been reported to range from approximately 35 ng ml-r to 56 ng ml-r. (Persson et al 1988 were significantly lower than in group 2, suggesting a dose-dependent effect.…”

Section: Discussionsupporting

confidence: 80%

High dose alfentanil pre-empts pain after abdominal hysterectomy

Katz

Clairoux

Redahan³

et al. 1996

Pain

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Summary This study tested the hypothesis that high dose systemic alfentanil administered before and during aMominal hysterectomy would pre-empt post'operative pain to a greater extent than administration of either low dose alfentanil or no alfentanil perioperatively. Patients (ASA I or 2) were randomly assigned to group 1 (r = 15), no opioid; group 2 (n = 15), low dose alfentanil; or group 3 (n = l5). high dose alfentanil. Anaesthesia was induced in group I with midazolam and thiopentone and was maintained with isoflurane andTO% N2O in 02, Anaesthesia was induced in group 2 with midazolam, thiopentone and i.v. alfentanil (30pg kg-l), and was maintained with isoflurane. 70VoN2O in 02, and bolus doses of i.v. alfentanil (10-20pg kg-l) every hour. Anaesthesia was induced in group 3 withmidazolamandi.v. alfentanl (l0opgkg-t),and wasmaintained wtlt70% N2Oin Oz,andanintusionof i.v. alfentanil(l-2pgkg-l min-l). Blood samples were drawn at 30 and 120 min after surgery and assayed for plasma alfentanil. Morphine consumption and VAS pain scores were consistently lowest in group 3 over the 48 h study period, A composite measure of pain and morphine consumption was significantly lower in group 3 than group 2 up to 6 h after surgery and significantly lower than group I up to 12 h. No adverse effects were observed. A 6-month follow-up did not reveal any significant differences among the three groups. It is concluded that intra-operative high dose alfentanil anaesthetic pre-empts post-oporative pain after abdominal hysterectomy, but the effects are small and of short duration.Surgical procedures carried out under general anaesthesia using standard (and even high) doses of opioids intraoperatively provide suboptimal protection from the injury banage brought about by incision and subsequent noxious surgical events.

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Section: Discussionsupporting

confidence: 80%

High dose alfentanil pre-empts pain after abdominal hysterectomy

Katz

Clairoux

Redahan³

et al. 1996

Pain

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“…Several studies have shown that potentials, evoked by noxious laser stimuli, correlate with perceived pain intensity [10,11,14,15]. In contrast, there is a lack of correlation between the amplitude of the vertex potential evoked by nociceptive electrical stimulation on the surface of the skin and subjective pain rating [16,17]. This suggests that transcutaneous electrically evoked vertex potentials are not a reliable measure or correlate for changes within the nociceptive system.…”

Section: Discussionmentioning

confidence: 41%

“…There was a reduction in the peak-to-peak amplitudes for the evoked vertex potentials elicited by nociceptive electrical and laser stimulation at the two higher isoflurane concentrations (see table 2), which could be interpreted as an analgesic effect [16,[20][21][22]. But the same decrease in the peak-to-peak amplitudes was observed also for the non-nociceptive AEP, and furthermore the perceived pain intensity did not differ significantly from baseline.…”

Section: Discussionmentioning

confidence: 56%

Analgesic effect in humans of subanaesthetic isoflurane concentrations evaluated by evoked potentials

Roth

Petersen-Felix

Bak

et al. 1996

British Journal of Anaesthesia

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SummaryThe aim of this study was to see if an analgesic effect of subanaesthetic concentrations of isoflurane could be detected with evoked potentials elicited by nociceptive stimuli. We studied 10 healthy volunteers breathing three steady-state subanaesthetic concentrations of isoflurane (0.08, 0.16 and 0.24 vol% end-tidal). Reaction time, subjective pain intensities and evoked vertex potentials to laser (LEP) and electrical (SEP) stimuli were recorded and compared with auditory evoked potentials (AEP). Compared with baseline, the subanaesthetic concentrations of isoflurane did not change the latencies of the evoked potentials, but caused a significant reduction in the amplitudes of the LEP and SEP at 0.16 and 0.24 vol% and of the AEP at all three concentrations. There were no changes in perceived pain intensity, and isoflurane produced similar reductions in evoked potentials elicited by both nociceptive and non-nociceptive stimuli. The reaction time was increased significantly at 0.24 vol% isoflurane. The results demonstated that subanaesthetic isoflurane concentrations caused similar changes in evoked potentials with both painful and non-painful stimuli, with no effect on perceived pain intensity. (Br.

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“…The optimal Ce for alfentanil should provide maximum pain relief with minimum side-effects. Alfentanil's analgesic effects are dose related 16 and vary between 40 ng/ml 10,17 and 110 ng/ml 8 for effective postoperative analgesia. Pavlin et al 10 found that combining propofol and alfentanil could produce sedation and analgesia that was greater than that observed with either drug alone.…”

Section: Resultsmentioning

confidence: 99%

Sedation with alfentanil and propofol for rhizotomies

Rensburg¹,

Conradie

2014

Southern African Journal of Anaesthesia and Analgesia

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Background: Patient safety during sedation for closed rhizotomies is improved when analgesia is optimised, rather than relying on deep sedation for patient comfort. This retrospective study determined the appropriate effect-site concentration (Ce) for alfentanil, in combination with a constant propofol infusion, for optimal pain control during sedation for closed rhizotomies. Airway maintenance is ensured by keeping patients responsive to verbal commands, albeit at the price of inevitable ventilatory depression. Method: The records of patients who received rhizotomies over a six-month period were studied retrospectively. Sixty-three outpatients were included. Patients rated the level of analgesia with each needle placement. If the Ce for alfentanil was adequate, it was kept constant. Otherwise, it was increased in 5 ng/ml increments with each needle placement until analgesia was effective, or up to the maximum Ce for alfentanil of 100 ng/ml. Propofol infusion at a constant Ce of 200 ng/ml was added. Results: Forty-eight per cent of patients reported being comfortable at a Ce for alfentanil of 70-75 ng/ml. Only 5% of patients requested the maximum Ce for alfentanil of 100 ng/ml. All of the patients experienced ventilatory depression, but a patent airway was maintained. The haemodynamic observations were within normal limits. According to the ward records, 16% of the patients complained of nausea, and there was one incident of vomiting. Conclusion: Combining alfentanil at a Ce for alfentanil of 70-100 ng/ml with propofol at 200 ng/ml is a safe and effective method for analgesia during sedation for closed rhizotomies.

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Dose effects of alfentanil in human analgesia

Cited by 17 publications

References 0 publications

High dose alfentanil pre-empts pain after abdominal hysterectomy

High dose alfentanil pre-empts pain after abdominal hysterectomy

Analgesic effect in humans of subanaesthetic isoflurane concentrations evaluated by evoked potentials

Sedation with alfentanil and propofol for rhizotomies

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