Effects of fentanyl on emergence characteristics from anesthesia in adult cervical spine surgery: a comparison of fentanyl-based and sevoflurane-based anesthesia

Inoue, Yoshitaka; Koga, Kazunori; Sata, Takeyoshi; Shigematsu, Akio

doi:10.1007/s00540-004-0278-9

Cited by 10 publications

(7 citation statements)

References 20 publications

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“…After a review of the titles and abstracts, 81 studies were selected and assessed for potential inclusion into this systematic review. After reading the full-text articles, 33 RCTs (published between 1994 and 2021) including 2209 participants were finally included ( Figure 1 ) [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ]. No unpublished trials were identified with our eligibility criteria in the clinicaltrial.gov register.…”

Section: Resultsmentioning

confidence: 99%

Opioid-Free Anesthesia Benefit–Risk Balance: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Salomé

Harkouk

Fletcher

et al. 2021

JCM

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Opioid-free anesthesia (OFA) is used in surgery to avoid opioid-related side effects. However, uncertainty exists in the balance between OFA benefits and risks. We searched for randomized controlled trials (RCTs) comparing OFA to opioid-based anesthesia (OBA) in five international databases. The co-primary outcomes were postoperative acute pain and morphine consumption at 2, 24, and 48 h. The secondary outcomes were the incidence of postoperative chronic pain, hemodynamic tolerance, severe adverse effects, opioid-related adverse effects, and specific adverse effects related to substitution drugs. Overall, 33 RCTs including 2209 participants were assessed. At 2 h, the OFA groups had lower pain scores at rest MD (0.75 (−1.18; −0.32)), which did not definitively reach MCID. Less morphine was required in the OFA groups at 2 and 24 h, but with very small reductions: 1.61 mg (−2.69; −0.53) and −1.73 mg (p < 0.05), respectively, both not reaching MCID. The reduction in PONV in the OFA group in the PACU presented an RR of 0.46 (0.38, 0.56) and an RR of 0.34 (0.21; 0.56), respectively. Less sedation and shivering were observed in the OFA groups with an SMD of −0.81 (−1.05; −0.58) and an RR of 0.48 (0.33; 0.70), respectively. Quantitative analysis did not reveal differences between the hemodynamic outcomes, although severe side effects have been identified in the literature. No clinically significant benefits were observed with OFA in terms of pain and opioid use after surgery. A clear benefit of OFA use was observed with respect to a reduction in PONV. However, more data on the safe use of OFAs should be collected and caution should be taken in the development of OFA.

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Section: Resultsmentioning

confidence: 99%

Opioid-Free Anesthesia Benefit–Risk Balance: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Salomé

Harkouk

Fletcher

et al. 2021

JCM

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“…Table 1 presents the trial characteristics. Fourteen trials investigated remifentanil as an intra-operative opioid regimen [25, 26, 28, 31, 32, 34-36, 38-41, 44, 47], five explored fentanyl [27,29,43,45,46], one alfentanil [33] and one sufentanil [37]; one trial compared fentanyl and alfentanil to a control group [30], and another, remifentanil, alfentanil and morphine to a control group [42]. All included trials administered volatile anaesthetics to maintain anaesthesia except five that administered propofol [27,30,31,36,39].…”

Section: This Investigation Was Conducted Following the 'Preferredmentioning

confidence: 99%

“…All included trials administered volatile anaesthetics to maintain anaesthesia except five that administered propofol [27,30,31,36,39]. Regarding the types of surgery, authors included patients scheduled for gynaecological surgery in eight trials [25-27, 31, 33, 37, 44, 45]; patients undergoing abdominal surgery in six trials [28,35,36,38,41,42]; and finally, we combined the remaining nine trials together into an 'other surgery' group [29,30,32,34,39,40,43,46,47].…”

Section: This Investigation Was Conducted Following the 'Preferredmentioning

confidence: 99%

Analgesic impact of intra‐operative opioids vs. opioid‐free anaesthesia: a systematic review and meta‐analysis

et al. 2019

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Efficacité analgésique d'une anesthésie avec opioïdes versus sans opioïdes : une revue systématique de la littérature avec méta-analyses [Analgesic impact of intra-operative opioids versus opioid free anesthesia: a systematic review and meta-analysis] Les opioïdes sont administrés durant l'intervention afin de contrôler la réponse sympathique à un stimulus chirurgical, mais aussi pour soulager la douleur postopératoire. Récemment, l'utilisation des opioïdes durant la chirurgie a été remise en question en raison de l'absence probable de bénéfice dans la phase postopératoire immédiat, mais aussi en raison des effets secondaires, tels que les nausées et vomissements postopératoires. Le but de cette méta-analyse est d'investiguer si l'utilisation d'opioïde intraopératoire comparée à une stratégie sans opioïde permet de diminuer les douleurs postopératoires sans augmenter le taux de nausées et vomissements postopératoires. Nous avons inclus des essais cliniques randomisés et contrôlés effectués chez des patients adultes pour tout type de chirurgie qui ont étudié l'efficacité analgésique postopératoire d'une administration intraopératoire d'opioïde avec soit l'administration d'un placebo, soit l'absence d'administration. L'analyse des 23 études identifiées avec plus de 1300 patients inclus a démontré que les scores de douleurs au repos (échelle de 0 à 10, 0 étant aucune douleur et 10 la pire douleur imaginable) à 2h postopératoire étaient équivalents dans les deux groupes, avec une différence moyenne (IC 95%) de 0,2 point (-0,2 à 0,5), p=0,38. Les taux de nausées et vomissements postopératoires étaient de 24% dans le groupe avec opioïde et 19% dans le groupe sans ce qui représente un risque relatif (IC 95%) de 0,77 (0,61 à 0,97), p=0,03. En conclusion, l'utilisation d'opioïde intraopératoire ne diminue pas les douleurs postopératoires, mais est associée à une augmentation des nausées et vomissements postopératoire.

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“…It was shown that the quality of emergence from anesthesia in patients with cervical spine surgery was improved with fentanyl-based anesthesia, with no difference between the use of propofol TCI and sevoflurane as a concomitant sedative agent with fentanyl [22]. Magni et al [23] stated that there were no differences in terms of emergence time and recovery of early cognitive function between sevoflurane-fentanyl and propofol-remifentanil-based anesthesia in patients undergoing craniotomy.…”

Section: Discussionmentioning

confidence: 98%

Remifentanil versus fentanyl compared in a target-controlled infusion of propofol anesthesia: quality of anesthesia and recovery profile

et al. 2010

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Effects of fentanyl on emergence characteristics from anesthesia in adult cervical spine surgery: a comparison of fentanyl-based and sevoflurane-based anesthesia

Abstract: The quality of emergence from anesthesia in patients with cervical spine surgery is improved with fentanyl-based anesthesia, but there is no difference between the use of propofol TCI and less than 1% sevoflurane as a concomitant sedative agent with fentanyl.

Cited by 10 publications

References 20 publications

Opioid-Free Anesthesia Benefit–Risk Balance: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Opioid-Free Anesthesia Benefit–Risk Balance: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Analgesic impact of intra‐operative opioids vs. opioid‐free anaesthesia: a systematic review and meta‐analysis

Remifentanil versus fentanyl compared in a target-controlled infusion of propofol anesthesia: quality of anesthesia and recovery profile

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