Evaluation of analgesic effect of two different doses of fentanyl in combination with bupivacaine for surgical site infiltration in cases of modified radical mastoidectomy: A double blind randomized study

Abstract

Background:Limited evidence supports the efficacy of peripheral route fentanyl and local anesthetic combination for postoperative analgesia. Our study was therefore designed to demonstrate the analgesic efficacy of two different doses of fentanyl in combination with bupivacaine for surgical site infiltration in patients undergoing modified radical mastoidectomy (MRM).Materials and Methods:60 patients undergoing MRM under general anesthesia were randomly allocated into two groups, first group receiving 0.5% bupivacaine at a dose of 2 mg/kg body weight with 50 μg fentanyl and second group receiving bupivacaine 0.5% at a dose of 2 mg/kg body weight with 100 μg fentanyl as infiltration of operative field in and around the incision site, after the incision and just before completion of surgery. In postoperative period pain, nausea-vomiting and sedation was recorded at 0 hr, 2, 4, 6, 12 and 24 hrs.Results:Both the combinations of bupivacaine and fentanyl (Group I and Group II) were effective for postoperative analgesia. In both the groups the Visual Analogue Scale (VAS) score was less than 3 at each time interval. None of the patients required rescue analgesia. The comparison of VAS scores at different intervals showed that group II had lower VAS scores at all time points.Conclusions:Fentanyl and bupivacaine combinations in doses of 50 and 100 μg along with 0.5% bupivacaine at a fixed dose of 2 mg/kg body weight are effective in the management of postoperative pain. Patients who received 100 μg fentanyl (Group II) had lower VAS scores as compared to the patients who received 50 μg fentanyl (Group I) with similar side effects.

Evaluation of analgesic efficacy of superficial cervical plexus block in patients undergoing modified radical mastoidectomy: A randomised controlled trial

“…The other modalities for pain relief in patients undergoing mastoidectomy include local infiltration and greater auricular nerve (GAN) block. Bhandari G et al [ 17 ] administered 12 mL infiltration both after the incision and just before completion of modified radical mastoidectomy with a combination of bupivacaine and fentanyl 50 or 100 μg. The authors observed that patients receiving fentanyl 100 μg had lower VAS score as compared to patients requiring fentanyl 50 μg at 4 and 6 h postoperatively.…”

Perioperative analgesia for patients undergoing otologic surgery: An evidence‐based review

“…Five RCTs reported on perioperative pain management for tympanomastoid surgery (Table ) . Pain was scored using a VAS, WBS, or a customized OPS.…”

“…Bhandari et al found that the combination of bupivacaine and 100 μg fentanyl for operative field infiltration was associated with better postoperative analgesia than the combination with 50 μg fentanyl . In both study groups the VAS score was <3 at each time interval, and the bupivacaine + fentanyl 100 μg group had lower VAS scores than the bupivacaine + fentanyl 50 μg group at all time intervals . Nalini et al investigated intramuscular lornoxicam 8 mg twice daily versus diclofenac 75 mg twice daily following radical mastoidectomy .…”

“…Postmastoidectomy analgesia can be achieved with NSAIDs such as lornoxicam or local anesthetic plus fentanyl infiltration at the surgical site . At this time, there is conflicting evidence for greater auricular nerve blocks in the management of postmastoidectomy pain, although these have the largest potential to reduce the need for opiates in the perioperative period .…”

Studi Retrospektif: Profil Penggunaan Obat Analgesik pada Pasien Pascatonsilektomi di Departemen SMF THT-KL RSUD Dr. Soetomo Surabaya Tahun 2015-2016

“…Adapun golongan non-opioid terdiri dari golongan salisilat, asam asetat, cyclooxygenase-2 (COX-2) inhibitor, fenamat, asam proprionat, asetaminofen, dan pirazolon. 16 Pemberian analgesik yang dimulai sejak hari pertama pascatonsilektomi telah diteliti dapat meringankan nyeri. 14 World Health Organization (WHO) telah mengeluarkan pedoman terbaru untuk mengatasi nyeri yang disebut New Adaptation of WHO Analgesic Ladder.…”