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

Baxter, Alan D.; Laganière, S.; Samson, Benoit; Stewart, James J. P.; Hull, Kathryn A.; Goernert, Lynne

doi:10.1007/bf03009829

Cited by 39 publications

(22 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2010

View full text Add to dashboard Cite

CONTEXT AND OBJECTIVE: Controversy exists regarding the site of action of fentanyl after epidural injection. The objective of this investigation was to compare the efficacy of epidural and intravenous fentanyl for orthopedic surgery. DESIGN AND SETTING:A randomized double-blind study was performed in Hospital São Paulo. METHODS:During the postoperative period, in the presence of pain, 29 patients were divided into two groups: group 1 (n = 14) received 100 µg of fentanyl epidurally and 2 ml of saline intravenously; group 2 (n = 15) received 5 ml of saline epidurally and 100 µg of fentanyl intravenously. The analgesic supplementation consisted of 40 mg of tenoxicam intravenously and, if necessary, 5 ml of 0.25% bupivacaine epidurally. Pain intensity was evaluated on a numerical scale and plasma concentrations of fentanyl were measured simultaneously. RESULTS:The percentage of patients who required supplementary analgesia with tenoxicam was lower in group 1 (71.4%) than in group 2 (100%): 95% confidence interval (CI) = 0.001-0.4360 (P = 0.001, Fisher's exact test; relative risk, RR = 0.07). Epidural bupivacaine supplementation was also lower in group 1 (14.3%) than in group 2 (53.3%): 95% CI = 0.06-1.05 (P = 0.03, Fisher's exact test; RR = 0.26). There was no difference in pain intensity on the numerical scale. Mean fentanyl plasma concentrations were similar in the two groups.CONCLUSION: Intravenous and epidural fentanyl appear to have similar efficacy for reducing pain according to the numerical scale, but supplementary analgesia was needed less frequently when epidural fentanyl was used. CLINICAL TRIAL REGISTRATION NUMBER: NCT00635986RESUMO CONTEXTO E OBJETIVO: Existem controvérsias sobre o local de ação do fentanil injetado por via peridural. O objetivo foi comparar a eficácia do fentanil peridural e do venoso em cirurgias ortopédicas. TIPO DE ESTUDO E LOCAL:Estudo aleatório, duplo-cego, realizado no Hospital São Paulo. MÉTODO:No pós-operatório, na presença de dor, 29 pacientes foram divididos em dois grupos: grupo 1 (n = 14) recebeu solução de 100 mcg de fentanil por via peridural e 2 ml de solução salina venosa; grupo 2 (n = 15), 5 ml de solução salina peridural e 100 µg de fentanil venoso. A complementação analgésica foi com 40 mg de tenoxicam venoso e, se necessário, 5 ml de bupivacaína 0.25%. A intensidade da dor foi avaliada pela escala numérica e a concentração plasmática do fentanil foi medida simultaneamente.RESULTADOS: A percentagem de pacientes que necessitaram de complementação analgésica com tenoxicam foi menor no grupo 1 (71.4% versus 100.0% grupo 2): intervalo de confiança, IC 95% = 0.001-0.4360 (P = 0.001, teste exato de Fisher; risco relativo, RR = 0.07). A complementação com bupivacaína peridural também foi menor no grupo 1 (14.3% versus 53.3% grupo 2): IC 95% = 0.06-1.05 (P = 0.03, teste exato de Fisher; RR = 0.26).Não houve diferença na intensidade da dor avaliada pela escala numérica. As concentrações plasmáticas do fentanil foram semelhantes nos dois grupos.CONCLUSÃO: A eficácia do...

show abstract

Section: Discussionmentioning

confidence: 99%

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

et al. 2010

View full text Add to dashboard Cite

show abstract

“…Several studies using epidural fentanyl infusions have demonstrated the development of minimal effective analgesic plasma concentrations of fentanyl, indicating rapid absorption of fentanyl from the epidural space. [37][38][39][40] In those studies in which fentanyl infusions (epidural or intravenous) were reduced by the observer in the event of excessive somnolence or respiratory depression, the resulting epidural and intravenous doses required for analgesia were similar as well as the subsequent plasma concentrations of fentanyl. [39.40] Camu and Debucquoy[4ll and Chauvin et aU42l found epidural alfentanil administration to be no more effective than intravenous injection in postoperative analgesia.…”

Section: Mode Of Administrationmentioning

confidence: 99%

Clinical Pharmacokinetics of Alfentanil, Fentanyl and Sufentanil

Scholz

Steinfath

Schulz

1996

Clinical Pharmacokinetics

235

114

View full text Add to dashboard Cite

Alfentanil, fentanyl and sufentanil are synthetic opioid analgesics acting at specific opioid receptors. These opioids are widely used as analgesics to supplement general anaesthesia for various surgical procedures or as primary anaesthetic agents in very high doses during cardiac surgery. Fentanyl and sufentanil especially are administered via infusion for long term analgesia and sedation in intensive care patients. Opioid analgesics are mainly administered using the intravenous route. However, other techniques of administration, including epidural, intrathecal, transdermal and intranasal applications, have been demonstrated. Important pharmacokinetic differences between alfentanil, fentanyl and sufentanil have been shown in many reports. Alfentanil has the most rapid analgesic onset and time to peak effect as well as the shortest distribution and elimination half-lives. The volume of distribution and total body clearance of this agent are smaller when compared with those of fentanyl and sufentanil. The pharmacokinetics of the opioid analgesics can be affected by several factors including patient age, plasma protein content, acid-base status and cardiopulmonary bypass, but not significantly by renal insufficiency or compensated hepatic dysfunction. In addition, pharmacokinetic properties can be influenced by changes in hepatic blood flow and administration of drug combinations which compete for the same plasma protein carrier or metabolising pathway. Although comparing specific pharmacokinetic parameters such as half-lives is deeply entrenched in the literature and clinical practice, simply comparing half-lives is not a rational way to select an opioid for specific requirements. Using pharmacokinetic-pharmacodynamic models, computer simulations based on changes in the effect site opioid concentration or context-sensitive half-times seem to be extremely useful for selecting an opioid on a more rational basis.

show abstract

“…However, their side-effects (respiratory depression and inhibition of the cough reflex) are undesirable after thoracotomy. [45] Non-steroidal anti-inflammatory drugs (NSAID) can be useful when administered in combination with opioids as a part of multimodal therapeutic strategy to reduce the need for opioids and to produce or ameliorate analgesia, but are not without side-effects of their own. [6]…”

Section: Introductionmentioning

confidence: 99%

The effect on post-operative pain of intravenous clonidine given before induction of anaesthesia

Samantaray¹,

Rao²,

Chandra³

2012

Indian J Anaesth

View full text Add to dashboard Cite

Background:Treatment of acute post-thoracotomy pain is particularly important not only to keep the patient comfortable but also to minimize pulmonary complications.Aim:This study was designed to test the effect of pre-induction administration of clonidine, given as a single intravenous dose, on post-operative pain scores and fentanyl consumption in patients after thoracic surgery.Setting and Design:Tertiary referral centre. Prospective, randomised, double-blind, placebo-controlled trial.Methods:Sixty patients were randomly allocated to receive clonidine (3 mcg/kg) or saline pre-operatively before induction of anaesthesia. The primary endpoint was pain on coughing (visual analogue scale (VAS) 0–100 mm) 120 min after surgery, time to first analgesic injection in the post-anaesthesia care unit (PACU) and 24-h fentanyl consumption.Statistical Analysis:For between-group comparisons, t-test and U-test were used as appropriate after checking normality of distribution. The incidence of complications between the groups was compared by Fisher's exact test.Results:The post-operative VAS for the first 120 min and the fentanyl consumption at 24 h was significantly greater in the placebo group compared with the clonidine group (P<0.05). The sedation score was increased in the clonidine group during study drug infusion, but did not differ significantly on admission to the PACU.Conclusions:A single intravenous dose of clonidine (3 mcg/kg) given before induction of anaesthesia significantly reduced the post-operative VAS score in the initial period and fentanyl consumption during 24 h after thoracic surgery.

show abstract

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

Cited by 39 publications

References 30 publications

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

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

Clinical Pharmacokinetics of Alfentanil, Fentanyl and Sufentanil

The effect on post-operative pain of intravenous clonidine given before induction of anaesthesia

Contact Info

Product

Resources

About