Patient-controlled lumbar epidural fentanyl compared with patient-controlled intravenous fentanyl for post-thoracotomy pain

Abstract

Thirty-four patients undergoing thoracotomy were entered into a randomized, double-blind, placebo-controlled study to compare the effects of patient-controlled, lumbar epidural (PCA-E) fentanyl with patient-controlled intravenous (PCA-iv) Trente-quatre patients devant subir une thoracotomie ont dtd ~valu~s dans le cadre d'une Etude h double insu, au hasard et avec contrOles placebo afin de comparer les effets du fentanyl Epidural contr~le par le patient (PCA-E) au fentanyl intraveineux contr61E par le patient (PCA-iv) face au besoin en mddicaments, ~ l' efficacit~ analg~sique et ~ la fonction respiratoire. Avant la fermeture du thorax, les patients ont refu 2 mg 9 kg -t de fentanyl par voie PCA-iv (n = 15) (1857 +-693 Izg vs 2573Epidural fentanyl has been investigated in patients undergoing a variety of surgical procedures with conflicting CAN J ANAESTH 1992 / 39:3 / pp214-9

Epidural versus intravenous fentanyl for postoperative analgesia following orthopedic surgery: randomized controlled trial

“…3,11,15,21 Some investigators found that the plasma concentration of fentanyl was much lower after epidural injection than after intravenous administration. 12,16 In the present study, only two patients in group 1 and one patient in group 2 presented a fentanyl concentration of 0.63 ng/ml during the period analyzed.…”

“…Several investigators [7][8][9][10][11][12][13][14][15][16][17][18][19][20] have evaluated the mechanism of action of fentanyl administered epidurally. Although many studies 3,9-12,15,17 have concluded that the mechanism of action is associated with systemic absorption of the opioid into the circulation, followed by a supraspinal effect, many investigators continue to use fentanyl as a continuous infusion.…”

Postoperative Effects of Opioid Analgesics Administered via Continuous Perfusion and Patient Controlled Analgesia after Open Heart Surgery

“…Some researchers compared epidural route and the above mentioned method and noted that there exists no diŠerence in e‹ciency, but former route is more advantageous for additional doses and that both methods are superior to intermittent dosing. 14) It was reported that intravenous analgesia with PCA after CABG operations is superior to conventional nurse determined analgesic administration as signiˆcantly less postoperative atelectasis with the former method. 9) In previous researches, it had been shown that patients in PCA group after CABG procedures had more rapidly decreasing VAS scores than those in conventional analgesia group.…”

A comparison of lumbar epidural and intravenous fentanyl infusions for post-thoracotomy analgesia

“…Is-E~ Recent studies have questioned whether the analgesic efficacy of epidural fentanyl is secondary to systemic absorption and recirculation to the central nervous system through the blood-brain bartier, 12,15,16,23 or is mediated by a direct spinal mechanism. 25 If the former were the case, then there may be no advantage to the epidural route.…”