Epidural and Intravenous Fentanyl Produce Equivalent Effects during Major Surgery

Guinard, J. P.; Carpenter, Randall L.; Chassot, Pierre‐Guy

doi:10.1097/00000542-199502000-00008

Cited by 37 publications

(14 citation statements)

References 23 publications

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“…Median time [IQR (range)] to awakening ( Fig. 3) was 8 min [4.5 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)] in the epidural group and 20 min [12.5 (7-34)] in the intravenous group (P < 0.001); the ANCOVA model rules out the possibility that the differences were related to the dose of propofol. When evaluating the time to analgesia request ( Fig.…”

Section: Resultsmentioning

confidence: 99%

“…1 Many authors hold that epidural administration of fentanyl is more effective than intravenous administration, suggesting a spinal site of action; [2][3][4][5][6] others claim that both routes of administration provide a similar degree of analgesia, suggesting a supraspinal site of action after vascular absorption from the epidural space and redistribution from there to the brain. [7][8][9][10] If the latter hypothesis is correct, epidural fentanyl should provide no benefit over systemic (i.e. intravenous) administration.…”

mentioning

confidence: 99%

“…However, the effectiveness of epidural lipophilic opioids in real clinical intraoperative conditions has been poorly studied, and contradictory results have been described. 3,4,8 Our working hypothesis was that epidural fentanyl (administered at the dosages recommended by Ginosar et al) would be more effective than intravenous fentanyl and that it would make it possible to reduce the total dose necessary to maintain intraoperative analgesia in major abdominal surgery via open laparotomy.…”

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confidence: 99%

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Epidural vs. intravenous fentanyl during colorectal surgery using a double‐blind, double‐dummy design

Sadurní

Heredia

Dürsteler

et al. 2013

Acta Anaesthesiol Scand

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Section: Resultsmentioning

confidence: 99%

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confidence: 99%

mentioning

confidence: 99%

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Epidural vs. intravenous fentanyl during colorectal surgery using a double‐blind, double‐dummy design

Sadurní

Heredia

Dürsteler

et al. 2013

Acta Anaesthesiol Scand

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“…Guinard et al found that fentanyl plasma concentration and the need for supplemental analgesia were similar in patients receiving fentanyl by epidural route and IV bolus supporting so a systemic mechanism of action. However the average dose of epidural fentanyl studied by these authors was larger than that studied by other investigators [48]. Menigaux et al studied postoperative pain management with IV and epidural sufentanil administered as small (5 mcg) repeated boluses and showed that plasma sufentanil concentrations were similar in both groups thus concluding that epidural sufentanil produced analgesia by systemic mechanism.…”

Section: Opioidsmentioning

confidence: 85%

New Drugs for Epidural Analgesia

Congedo

Sgreccia

Cosmo

2009

CDT

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In recent years there has been a wide use of the epidural technique not only during surgery to provide anesthesia and analgesia, but also for obstetric and trauma as well as acute, chronic and cancer pain states. Nowadays there is an increase in the number of the epidural drugs. Local anesthetics and opioids are still the pharmacological agents more widely used epidurally, nevertheless other drugs from different pharmacological classes are administered as adjuvant to local anesthetics and opioids or are in various early stages of investigation. Regarding to local anesthetics, the most recent literature focuses on the new enantiomers, ropivacaine and levobupivacaine, the efficacy of which is similar to that of bupivacaine with a reduced risk of cardiotoxicity. About opioids, the other class of drugs mainly used, the debate, in the last years, concerned the physicochemical properties of morphine and of the more recent lipophilic agents, fentanyl and sufentanil, in order to explain the main differences in efficacy and safety. Other categories of agents have been investigated for epidural administration, such as alpha(2)-adrenergic agonists clonidine and dexmedetomidine. They are being used increasingly as adjuvants to local anesthetics and opioids. Ketamine and neostigmine, the more recent studied drugs for epidural use, are still under investigation and are not part of routine clinical practice.

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“…Cumulative postoperative opioid consumption was reported in oral morphine equivalents over 24-h periods for the first 72 h. Fentanyl delivered through the neuraxial route was considered equivalent to intravenous fentanyl and converted to oral morphine equivalents using defined scales [Table 1]. [1617] Secondary objectives were to determine whether the PVB group differed from the TE or PCA groups in pain scores, the incidence of nausea and vomiting, the frequency of antiemetic administration, time to first oral intake after PACU discharge, intraoperative hypotension, and intraoperative administration of catecholamine.…”

Section: Methodsmentioning

confidence: 99%

Postoperative pain management in patients undergoing thoracoscopic repair of pectus excavatum: A retrospective analysis of opioid consumption and adverse effects in adolescents

et al. 2017

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Introduction:Although the Nuss procedure provides excellent cosmetic results for the correction of pectus excavatum, the provision of analgesia following such procedures can be challenging.Methods:The current study retrospectively reviews our experience over a 2.5 year period with thoracic epidural analgesia (TE), paravertebral blockade (PVB), and intravenous opioids delivered via patient-controlled analgesia (PCA) to provide postoperative analgesia.Results:The study cohort included 30 patients (mean age = 15.6 ± 1.5 years), 15 of whom were treated with PCA, 8 with TE, and 7 with PVB. There were no significant differences in pain scores between the 3 groups at any time point during the first 3 postoperative days. Compared to PCA, the PVB group had lower opioid consumption over the first 24 hours of hospitalization by 1.7 mg/kg morphine equivalents (95% CI of difference: 0.1, 3.3; p=0.035); but had higher opioid consumption by 2.0 mg/kg morphine equivalents than the TE group (95% CI of difference: 0.3, 3.7; p=0.024). There were no differences in opioid consumption between PVB and PCA or between PVB and TE at 48 or 72 hours. The number of intraoperative hypotension episodes was significantly lower in the PCA group when compared to the PVB group (p=0.001), with no difference between the PVB and TE groups.Conclusions:The use of regional anesthesia should be considered a viable option for the relief of postoperative pain in pediatric patients following the Nuss procedure albeit with a higher incidence of intraoperative hemodynamic effects. A randomized, prospective, study powered to compare all 3 techniques against one another would be necessary to confirm the significance of these findings.

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Epidural and Intravenous Fentanyl Produce Equivalent Effects during Major Surgery

Abstract: There appears to be no clinical advantage to epidural administration of fentanyl over intravenous administration during anesthesia for major surgery.

Cited by 37 publications

References 23 publications

Epidural vs. intravenous fentanyl during colorectal surgery using a double‐blind, double‐dummy design

Epidural vs. intravenous fentanyl during colorectal surgery using a double‐blind, double‐dummy design

New Drugs for Epidural Analgesia

Postoperative pain management in patients undergoing thoracoscopic repair of pectus excavatum: A retrospective analysis of opioid consumption and adverse effects in adolescents

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