Thoracic epidural infusion for postoperative pain relief following abdominal aortic surgery: bupivacaine, fentanyl or a mixture of both?

George, K. A.; Chisakuta, A M; Gamble, J. A. S.; Browne, Gail

doi:10.1111/j.1365-2044.1992.tb02218.x

Cited by 84 publications

(34 citation statements)

References 34 publications

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“…This may be why more patients had pain (VAPS score > 2) during the first 2 postoperative hours than after 4 h. It may also account for the relatively low mean fentanyl and sufentanil requirement compared with other studies. The mean administered dose, 27.5/~g/h fentanyl, was less than in comparable studies in which 46-60 /~g/h fentanyl was administered [12][13][14]. The distribution of the patients over the VAPS 8 classes is in accordance with the results of George et al [14].…”

Section: Postoperative Studysupporting

confidence: 81%

Epidural fentanyl and sufentanil for intra- and postoperative analgesia

Wilhelm¹,

Dieleman²

1994

Pharm World Sci

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In a double-blind, randomized study the efficacies of concentrated fentanyl and sufentanil injections as intraoperative epidural analgesics were compared. Also, the equivalent dose of fentanyl and sufentanil administered by continuous infusion during the first 24 h postoperatively, expressed in analgesia and also considering the side-effects was determined. 53 Patients undergoing elective thoracotomy, aortic surgery and bowel surgery were randomized and treated double-blind with fentanyl 0.250 mg/ml or sufentanil 0.05 mg/ml. Preoperatively, 0.5-1 ml study medication was administered, followed by increments of 0.2-0.5 ml during surgery guided by heart rate and systolic blood pressure. Postoperatively, study medication diluted in 1.25 mg/l bupivacaine was administered by continuous epidural infusion. The infusion rate was adjusted to optimize analgesia. Dose, heart rate and systolic blood pressure were measured intra- and postoperatively. Pain, sedation, nausea and pruritus were assessed on a 10 cm visual analogue scale. There were no differences in required volume of study medication, heart rate and systolic blood pressure nor in the parameters assessed postoperatively. Administered doses were 27.5 micrograms/h fentanyl and 5.5 micrograms/h sufentanil. It was concluded that 0.250 mg/ml (0.74 mumol/ml) fentanyl is clinically equivalent to 0.050 mg/ml (0.13 mumol/ml) sufentanil.

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Section: Postoperative Studysupporting

confidence: 81%

Epidural fentanyl and sufentanil for intra- and postoperative analgesia

Wilhelm¹,

Dieleman²

1994

Pharm World Sci

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“…From these data we calculated approximately equipotent 24-h dosages for each drug. Previous studies have demonstrated superior analgesia with a combination of opioid and bupivacaine with the possible exception of very high dose fentanyl and therefore the use of bupivacaine alone or opioid alone were not considered ethical [10,[24][25][26][27][28].…”

Section: Discussionmentioning

confidence: 99%

Side‐effects of epidural infusions of opioid bupivacaine mixtures

Gedney

Liu

1998

Anaesthesia

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SummaryThe incidence of side-effects occurring with epidural diamorphine (0.05 mg.ml ¹1 ), fentanyl (2.0 mg.ml ¹1 ), methadone (0.1 mg.ml ¹1 ), morphine (0.05 mg.ml ¹1 ) and pethidine (1.0 mg.ml ¹1 ) used by infusion in combination with bupivacaine has been compared. One hundred and sixty patients were studied, 32 receiving each opioid. The incidence of nausea and vomiting was significantly greater with morphine than fentanyl (p ¼ 0.0097) and pethidine (p ¼ 0.0021). The incidence of pruritis was significantly greater with morphine and diamorphine than with methadone (p ¼ 0.012) and pethidine (p ¼ 0.027). Morphine was also associated with a significantly greater incidence of urinary retention than pethidine (p ¼ 0.012) and methadone (p ¼ 0.025).

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“…It is common practice to infuse a mixture of bupivacaine 0.1-0.25% with an opioid for postoperative analgesia [11][12][13][14]. A relatively low concentration of bupivacaine (0.0625%) plus fentanyl 3.3 mg.ml ¹1 has been chosen as our standard analgesic protocol and most of these patients are monitored in the general ward.…”

Section: Discussionmentioning

confidence: 99%

An audit of the safety of an acute pain service

et al. 1997

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SummaryWe audited and analysed the adverse effects and safety of postoperative pain management on 2509 consecutive patients under care of the Acute Pain Service at a tertiary referral teaching hospital over a 32-month period. Our standard respiratory monitoring consisted of continuous pulse oximetry, hourly respiratory rate counting, sedation scoring and intermittent arterial blood gas sampling. This protocol was reliable and detected six episodes of bradypnoea, 13 of hypercapnia and 23 of oxygen desaturation occurring in 39 patients (1.8% of all spontaneously breathing patients). Two patients required naloxone injection and none had long-term sequelae. Hypotension due to epidural bupivacaine 0.0625% and fentanyl 3.3 mg.ml ¹1 infusion occurred in four patients (1.2%), all with a sensory block higher than T 5 . They readily responded to fluid infusion and ephedrine (two patients). Postoperative nausea or vomiting occurred in 723 (28.8%) and 380 (15.1%) patients, respectively. Odds ratio analysis showed that the risk factors for postoperative nausea and vomiting were: female gender, gynaecological operations, nongeriatric patients and systemic analgesia. Postoperative nausea and vomiting decreased analgesic efficacy by discouraging the use of patient-controlled analgesia and was regarded as equally distressing as pain. Other side-effects included: pruritus in 182 patients; dizziness in 333 and lower limb weakness in 73 (21.2% of patients receiving epidural local anaesthetics). It is concluded that a standard monitoring and management protocol, an experienced nursing team and reliable Acute Pain Service coverage is mandatory for the safe use of modern analgesic techniques.

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Thoracic epidural infusion for postoperative pain relief following abdominal aortic surgery: bupivacaine, fentanyl or a mixture of both?

Cited by 84 publications

References 34 publications

Epidural fentanyl and sufentanil for intra- and postoperative analgesia

Epidural fentanyl and sufentanil for intra- and postoperative analgesia

Side‐effects of epidural infusions of opioid bupivacaine mixtures

An audit of the safety of an acute pain service

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