Comparison of low dose intravenous fentanyl and morphine infusion for postoperative analgesia in spine fusion surgeries – a randomized control trial

Venkatraman, Rajagopalan; Pushparani, Anand; Ramraj, Balaji; Nandhini, P

doi:10.1016/j.bjane.2020.12.013

Cited by 5 publications

(5 citation statements)

References 16 publications

(14 reference statements)

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“…Furthermore, these routes of administration are indicated in patients who need a rapid dose increase [ 129 ] to treat different types of pain [ 130 , 131 , 132 ]. The intravenous route is also exploited, particularly for postoperative analgesia [ 127 , 133 ]. Finally, recent studies have shown that morphine not only plays a role in cancer relief but may also be involved in the regulation of tumor growth, angiogenesis, metastasis, inflammation and immunity.…”

Section: The Pharmacological Approachmentioning

confidence: 99%

Pharmacological Treatments and Therapeutic Drug Monitoring in Patients with Chronic Pain

De Rosa,

Giannatiempo,

Charlier

et al. 2023

Pharmaceutics

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Pain is an unpleasant sensory and emotional experience that affects every aspect of a patient's life and which may be treated through different pharmacological and non-pharmacological approaches. Analgesics are the drugs most commonly used to treat pain, and in specific situations, the use of opioids may be considered with caution. These drugs, in fact, do not always induce optimal analgesia in patients, and several problems are associated with their use. The purpose of this narrative review is to describe the pharmacological approaches currently used for the management of chronic pain. We review several aspects, from the pain-scale-based methods currently available to assess the type and intensity of pain, to the most frequently administered drugs (non-narcotic analgesics and narcotic analgesics), whose pharmacological characteristics are briefly reported. Overall, we attempt to provide an overview of different pharmacological treatments while also illustrating the relevant guidelines and indications. We then report the strategies that may be used to reduce problems related to opioid use. Specifically, we focus our attention on therapeutic drug monitoring (TDM), a tool that could help clinicians select the most suitable drug and dose to be used for each patient. The actual potential of using TDM to optimize and personalize opioid-based pain treatments is finally discussed based on recent scientific reports.

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Section: The Pharmacological Approachmentioning

confidence: 99%

Pharmacological Treatments and Therapeutic Drug Monitoring in Patients with Chronic Pain

De Rosa,

Giannatiempo,

Charlier

et al. 2023

Pharmaceutics

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“…opioids are commonly delivered via patient-controlled analgesia (PCA) devices, which may not be readily available in some settings. Venkatraman et al [7] performed an RCT of 100 spinal fusion patients to assess the effectiveness of 0.02 mg/kg/h continuous morphine infusion and 0.3 mcg/kg/h continuous fentanyl infusion to manage postoperative pain. They found that patients receiving continuous morphine infusion required fewer rescue analgesics than those receiving continuous fentanyl infusions without significant differences in pain scores.…”

Section: Fentanyl and Morphinementioning

confidence: 99%

“…However, there was a higher incidence of nausea in the morphine group and one patient in the morphine group required oxygen supplementation to treat oxygen desaturation to 88%. In this small study, continuous low dose opioid infusion seems safe but no comparison to controls using a PCA was made [7].…”

Section: Fentanyl and Morphinementioning

confidence: 99%

Postoperative analgesia for complex spinal surgery

Koh

Leslie

2022

Current Opinion in Anaesthesiology

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Purpose of reviewComplex spinal surgery is associated with significant postoperative pain. The purpose of this paper is to review recent literature on postoperative pain management in adult and adolescent patients having complex spinal surgery.Recent findingsWe conducted a literature search using the Medline database for relevant publications from 2020 to 2022 on postoperative pain after complex spinal surgery. Although opioids remain the mainstay to manage pain after complex spinal surgery, they are associated with adverse effects. Multimodal analgesia may be used to reduce these adverse effects by combining different drugs targeting different parts of the pain pathway. Recent publications suggest continuous low dose fentanyl or morphine infusion, methadone, intravenous paracetamol and ibuprofen, ketorolac, ketamine, magnesium infusion, lidocaine infusion and dexmedetomidine appear to be effective and safe to manage pain after complex spinal surgery. Regional techniques including bilateral erector spinae block, interfascial plane block and intrathecal morphine also appear to be effective and safe.SummaryPain management after complex spinal surgery remains challenging. Therefore, further studies are still required to determine the optimal multimodal analgesic regimen for these patients.

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“…Fentanyl is the potent synthetic opioid frequently used as an analgetic in intubated patients and severe cases of pain. Nevertheless, there is an individual's variability in response to fentanyl that causes the dosage from one patient and others to be different [2].…”

Section: Introductionmentioning

confidence: 99%

Alteration of Interleukin-4, Interleukin-6 Levels, and Post-operative Pain Intensity

Indra

Lipoeto²,

Tjong³

et al. 2023

Open Access Maced J Med Sci

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INTRODUCTION: Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. Pain can be both a symptom of tissue trauma associated with surgery or disease in itself. Surgical procedures may induce different alterations of interleukin (IL)-4 and IL-6 that affect the variation of pain intensity during surgery. Therefore, appropriate pain management during a surgical procedure may reduce postoperative morbidity caused by surgical pain. METHODS: This prospective cohort study included patients by consecutive sampling from all general anaesthetic patients in Dr. M Djamil Hospital and Andalas University Hospital, Padang, West Sumatera. We collected data from early November 2021 until the end of January 2022 and got 90 patients that suit the criteria. All patients signed informed consent to check their interleukin level and pain intensity before and after surgery. We assessedIL-4 and IL-6 using the Sandwich-ELISA technique and pain intensity using the numeric rating scale (NRS). We also measured length of surgery and its correlation to IL-4, IL-6, and NRS score. Patients were anesthetized with General Anesthesia and received the same fentanyl range of dosage (3-5) mcg/kg Ketorolac 30 mg and Tramadol 100 mg intravenous were given for postoperative analgesia. RESULT: We found a significant correlation between ΔIL-6 with surgical procedures, ΔNRS score, and length of surgery p = 0.039, p = 0.002, and p = 0.008, respectively). Whereas ΔIL-4 shows no significant correlation to surgical procedures, ΔNRS score, and length of operation (0.868, 0.195, and 0.112, respectively). Our result also found a significant correlation between ΔNRS and surgical procedures (p = 0.013). CONCLUSION: Surgical procedures with severe tissue trauma may trigger high secretion of ΔIL6 and stimulate high pain intensity after the surgical procedure.

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Comparison of low dose intravenous fentanyl and morphine infusion for postoperative analgesia in spine fusion surgeries – a randomized control trial

Cited by 5 publications

References 16 publications

Pharmacological Treatments and Therapeutic Drug Monitoring in Patients with Chronic Pain

Pharmacological Treatments and Therapeutic Drug Monitoring in Patients with Chronic Pain

Postoperative analgesia for complex spinal surgery

Alteration of Interleukin-4, Interleukin-6 Levels, and Post-operative Pain Intensity

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