The effects of adjuvant intrathecal fentanyl on postoperative pain and rebound pain for anorectal surgery under saddle anesthesia

Abstract

BackgroundIntrathecal opioid has been known to enhance the quality and prolong the duration of spinal anesthesia, as well as to reduce postoperative pain. The purpose of this study was to evaluate postoperative analgesic characteristics of intrathecal fentanyl for the first 48 hours after anorectal surgery under saddle anesthesia.MethodsEighty patients were recruited in our study. Forty patients were randomly allocated to group B that received 0.5% bupivacaine 5 mg with 0.3 ml normal saline. The other 40 patients were assigned to group BF which was given 0.5% bupivacaine 5 mg with fentanyl 15 μg. The primary outcome variable was a numeric rating scale (NRS) at six hours postoperatively. Secondary outcomes included changes in the NRS score between one and 48 hours postoperatively, consumption of rescue analgesics, and the frequency of rebound pain.ResultsGroup BF exhibited a lower mean NRS score at postoperative six hours compared to group B (P < 0.001). However, the mean NRS score was not different after postoperative six hours between the two groups. The median consumption of rescue analgesics in group BF was less than that of group B (P = 0.028) and the frequency of rebound pain decreased in group BF when compared to group B (P = 0.021). The levels of sensory block were S1 dermatome and motor block scores were 0 for both groups. There was no significant difference in adverse effects between the groups.ConclusionsIntrathecal fentanyl 15 μg for anorectal surgery under saddle anesthesia led to an improved pain score for the first six hours after surgery and decreased postoperative analgesic use. Rebound pain diminished with intrathecal fentanyl and adverse effects did not increase.

Spinal fentanyl for primary total hip arthroplasty: A double-edged sword? A clinical audit data analysis

“…However, there is evidence that intrathecal fentanyl could even attenuate these mechanisms in anorectal surgery. [ 3 ] The predominance of the visceral component of pain, as opposed to the somatic one, could also play a role.…”

“…Previous reports indicate that it could improve postoperative analgesia after obstetric interventions and rebound pain after perineal surgery under spinal anaesthesia. [ 3 ] However, there are few references related to its influence on analgesia after major lower limb trauma surgery. [ 4 ] The aim of the present study was to evaluate the influence of anaesthetic management on postoperative pain after primary total hip arthroplasty (PTHA).…”

Pain control in Extracorporeal Shock Wave Lithotripsy (ESWL): A narrative review based on pharmacological and non-pharmacological methods

“…Fentanyl is a fat-soluble narcotic that is effective and safe in causing analgesia as a single dose or as a continuous infusion (64)(65). Various studies indicate that the use of fentanyl controls pain after surgery (66)(67)(68)(69). In the study conducted by Iraklis C Mitsogiannis (21), Mehrabi (39), the effectiveness of acetaminophen drug in controlling pain in SWL has been proven.…”

Comparison of analgesic efficacy of bupivacaine, bupivacaine with dexmedetomidine, and bupivacaine with fentanyl in local perianal infiltration technique in perianal surgeries: A prospective, randomized controlled study

“…Ano-rectal surgeries have conventionally been performed under general anesthesia (GA) and spinal anesthesia (SA) 1 . Postoperative pain is said to be most severe in anorectal surgery and thus, the choice of anesthetic methods in this procedure is crucial to reduce the postoperative pain as well as postoperative complications 3 . Spinal anesthesia for anorectal surgery is a 04 July 2020 popular and commonly used method characterized by rapid onset and offset, easy mobilization and short hospital stay 4 .…”

“…No matter how skillfully conducted or successful the result, almost all surgical procedures produce tissue trauma and pain. Immediate pain is very severe in anorectal surgery and difficult to control with only intravenous analgesics 3 . Conventionally, nonsteroidal antiinflammatory drugs (NSAIDs) and opiates have often been used to control pain, but their use is confined to a short period of time and is associated with frequent side effects, including gastrointestinal problems, renal dysfunction, nausea and vomiting, increased urinary retention, and reduced bowel mobility 5 .…”