Epidural vs. intravenous infusion of alfentanil in the management of postoperative pain following laparotomies*

Nieuwenhuyzen, Marjolein C. O. van den; Burm, A. G. L.; Vletter, A. A.; Stienstra, Rudolf; Kleef, Jack W. van

doi:10.1111/j.1399-6576.1996.tb05573.x

Cited by 12 publications

(5 citation statements)

References 24 publications

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“…Since the current practice in the UK is to use postoperative regimens with insufficiently high concentrations of opioids to elicit spinal analgesia, the full potential of epidural opioids is not being realised. There is plenty of evidence showing that higher concentrations produce segmental analgesia and that these can be used clinically [11–24], and this evidence should be utilised and built upon.…”

Section: Resultsmentioning

confidence: 99%

“… that fentanyl has an equivalent potency when given epidurally and i.v. [11–22]; that there are equal plasma drug levels for epidural and i.v. analgesic regimens of equal potency [13–15, 17–23]; that there is a non‐segmental analgesic effect after the epidural administration of the drug [24].…”

Section: The Site Of Action Of Epidural Opioids – a Review Of The Evimentioning

confidence: 99%

“…that there are equal plasma drug levels for epidural and i.v. analgesic regimens of equal potency [13–15, 17–23];…”

Section: The Site Of Action Of Epidural Opioids – a Review Of The Evimentioning

confidence: 99%

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The site of action of epidurally administered opioids and its relevance to postoperative pain management

George

2006

Anaesthesia

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Summary The use of epidurally administered opioids to control postoperative pain is a well established and widely accepted technique. However, despite this longstanding use, there is still an ongoing debate concerning the site of action of the opioids used. Some argue that analgesia is mediated by a spinal mechanism and others that a supraspinal mechanism is responsible. On close inspection of the evidence it becomes apparent that epidural opioids act predominantly spinally when administered as a bolus, and predominantly supraspinally when administered as a continuous infusion. A concentration of 10 μg.ml−1 appears to be the threshold at which epidurally administered fentanyl can elicit segmental analgesia, a value which may have significant clinical applications. The evidence supporting a synergistic relationship between epidural opioids and local anaesthetics is weak and unsupported by a plausible physiological mechanism. Thus the ‘threshold concentration’ of approximately 10 μg.ml−1 is unlikely to be lowered by co‐administering opioids with local anaesthetics.

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Section: Resultsmentioning

confidence: 99%

Section: The Site Of Action Of Epidural Opioids – a Review Of The Evimentioning

confidence: 99%

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The site of action of epidurally administered opioids and its relevance to postoperative pain management

George

2006

Anaesthesia

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“…Postoperative pain is undertreated for varied reasons viz., lack of knowledge regarding effective dose ranges, duration of action of opioids and unfounded fear of respiratory depression and addiction. However, strong opioids viz., morphine,[ 1 ] fentanyl,[ 2 ] alfentanyl,[ 3 ] etc., have always been the gold standard in the management of postoperative pain. The major hindrance to the liberal use of strong opioids in the postoperative zone is the threat of respiratory depression[ 4 ] especially in children where the optimal dose for effective pain control is higher than in adults because of a larger volume of distribution[ 5 ] posing a relatively narrow margin of safety.…”

Section: Discussionmentioning

confidence: 99%

Comparison of preoperative rectal paracetamol with paracetamol - diclofenac combination for postoperative analgesia in pediatric surgeries under general anesthesia

Yallapragada

Shenoy

2016

Anesth Essays Res

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Context:Traditionally, pain in children is a topic that has received only minimal attention. However, in the recent times, considerable progress has been made in the field of neonatal and pediatric pharmacology. The concept of preemptive analgesia is important in combating postoperative pain in children. In this study, we sought to compare the effectiveness of preemptive analgesia provided by paracetamol alone and by its combination with diclofenac when administered per rectum.Aims:To compare the efficacy of preoperative rectal paracetamol with paracetamol - diclofenac combination for postoperative analgesia in pediatric surgeries under general anesthesia.Settings and Design:Prospective randomized double-blind study.Subjects and Methods:Sixty children scheduled for various surgeries under general anesthesia were randomly allocated into two Groups A and B, with 30 in each. Children in Group A received paracetamol suppository 20 mg/kg and those in Group B received paracetamol 20 mg/kg + diclofenac 2 mg/kg as suppository immediately after tracheal intubation. All the children were assessed for 24 h from the time of extubation. The pain was measured using numerical rating scale in children above 7 years and face-legs-activity-cry-consolability scale in children below 7 years. The time interval between extubation and the administration of the first dose of rescue analgesic was taken as the duration of postoperative analgesia.Statistical Analysis Used:Descriptive and inferential statistical methods were used to analyze the data.Results:The duration of postoperative analgesia was significantly longer in paracetamol + diclofenac group (21.13 ± 2.68 h) as compared to paracetamol alone group (10.18 ± 2.39 h).Conclusions:The combination of paracetamol and diclofenac administered per rectum preoperatively is more effective than paracetamol alone in providing postoperative analgesia in children.

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“…Van den Nieuwenhuyzen et al. reported that epidural and intravenous infusions of alfentanil resulted in equivalent, subanalgesic, plasma concentrations and in similar postoperative morphine consumption (25). Also, they were unable to demonstrate a spinal mechanism of action of epidurally administered alfentanil.…”

Section: Discussionmentioning

confidence: 99%

The comparison of caudal ketamine, alfentanil and ketamine plus alfentanil administration for postoperative analgesia in children

Özbek¹,

Bilen²,

Özcengiz³

et al. 2002

Pediatric Anesthesia

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Epidural vs. intravenous infusion of alfentanil in the management of postoperative pain following laparotomies*

Abstract: Compared to intravenous infusion of alfentanil epidural infusion resulting in the same plasma concentrations is not more effective in relieving postoperative pain. In view of this observation we were not able to demonstrate a spinal mechanism of alfentanil.

Cited by 12 publications

References 24 publications

The site of action of epidurally administered opioids and its relevance to postoperative pain management

The site of action of epidurally administered opioids and its relevance to postoperative pain management

Comparison of preoperative rectal paracetamol with paracetamol - diclofenac combination for postoperative analgesia in pediatric surgeries under general anesthesia

The comparison of caudal ketamine, alfentanil and ketamine plus alfentanil administration for postoperative analgesia in children

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