Patient‐controlled epidural fentanyl following spinal fentanyl at Caesarean section

Abstract

SummarySpinal fentanyl can improve analgesia during Caesarean section. However, there is evidence that, following its relatively short-lived analgesic effect, there is a more prolonged spinal opioid tolerance effect. The effectiveness of postoperative epidural fentanyl analgesia may therefore be reduced following the use of spinal fentanyl at operation. This randomised, double-blind study was designed to assess whether patient-controlled epidural fentanyl could produce effective analgesia following 25 lg of spinal fentanyl at operation. Patients undergoing elective Caesarean section received spinal bupivacaine combined with either fentanyl 25 lg (fentanyl group; n 18) or normal saline (saline group; n 18). Patient-controlled epidural fentanyl was used for postoperative analgesia. The fentanyl group used a mean of 23.4 (SD 14.5) lg.h

Which administration route of fentanyl better enhances the spread of spinal anaesthesia: intravenous, intrathecal or both?

“…The latter in particular was an important finding because as far as we know this is the first human study showing the concurrent administration of fentanyl by both spinal and systemic routes. Cooper et al (6) showed that epidural fentanyl produced more effective analgesia after the use of spinal fentanyl during Caesarean section. A number of animal studies have reported that the combined administration of spinal and systemic µ‐opioid agonists can produce a synergistic antinociceptive effect (5, 7, 8).…”

Intraoperative Use of Remifentanil for TIVA: Postoperative Pain, Acute Tolerance, and Opioid-Induced Hyperalgesia

“…[16][17][18][19]21,22,24 Differences in the cumulative intraoperative opioid dose could at least partially explain the divergent findings. Focusing on studies administering remifentanil indicates that aggravated postoperative pain and/or increased opioid consumption was consistently reported if patients received a cumulative dose greater than 50 µg/kg but could not reliably be detected if patients received a smaller cumulative dose (Fig 2).…”

Recent Developments in Patient-Controlled Analgesia

“…125 Intravenous PCA was used for the comparison of locoregional and spinal techniques, for example, epidural analgesia with morphine or bupivacaine, each in combination with clonidine, 126 spinal anesthesia with bupivacaine and intrathecal or oral clonidine, 127 intrathecal morphine and sufentanil, 128 intrathecal morphine and bupivacaine, 129 or spinal anesthesia versus iliohypogastric-ilioinguinal peripheral nerve block. 130 Drug interactions during PCEA were studied for spinal bupivacaine and fentanyl, 131 epidural bupivacaine or ropivacaine alone 132 or in combination with morphine, 133 epidural bupivacaine or ropivacaine with sufentanil, [134][135][136][137] or for sufentanil dose finding for ropivacaine supplementation. 138 To investigate effective methods for reducing postoperative nausea and vomiting during opioid PCA, cyclizine, 139 dexamethasone, 140 or ondansetron 125,139,141 were tried with varying success rates.…”