Epidural and Intravenous Fentanyl Infusions Are Clinically Equivalent After Knee Surgery

Abstract

The management of postoperative pain with continuous epidural fentanyl infusion was compared with continuous intravenous fentanyl infusion. In a randomized, doubleblind protocol we prospectively studied 20 patients undergoing repair of the anterior cruciate ligament of the knee. The quality of analgesia and the incidence of side effects were documented. Compared with patients receiving continuous intravenous fentanyl infusion, at 18 h postoperatively patients given continuous epidural fentanyl infusion reported similar pain scores both at rest (22 +/- 25 vs 27 +/- 21, P = 0.52) and with ambulation (59 +/- 18 vs 56 +/- 22, P = 0.82). Plasma fentanyl levels were 1.8 +/- 0.4 and 1.7 +/- 0.4 ng/mL (P = 0.91) for the intravenous and epidural groups, respectively. There were no significant differences in the incidence of nausea, pruritus, or urinary retention. There was no respiratory depression in either group. We conclude that when compared with continuous intravenous fentanyl infusion, continuous epidural fentanyl infusion offers no clinical advantages for the management of postoperative pain after knee surgery.

Effect of epidural administration of lidocaine, fentanyl and their combination on the minimum alveolar concentration of halothane in dogs

“…Real advantage of fentanyl given epidurally is clearly in its local effect, which should be similar as effect systemic (Loper et al, 1990). In our study, however, we would expect be�er analgesia, as reported by Inagaki et al (1992).…”

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

“…11,13,21 This finding shows that both intravenous and epidural fentanyl promoted good pain relief within the first 30 minutes. However, after this period, part of the analgesic effect was mediated by supplementation.…”

“…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.…”

“…2 The plasma fentanyl concentrations observed at different times were similar to those reported in other studies. 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.…”

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

“…After epidural injection, there is rapid uptake of fentanyl into epidural blood vessels as well as into the spinal cord, and blood concentrations obtained after lumbar epidural infusion 8:2,15-17 have often been in the range reported as being effective analgesic blood concentrations with systemic infusions. 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.…”