Ventilatory Response to Carbon Dioxide During Extradural Anaesthesia With Lignocaine and Fentanyl

Morisot, P; Dessanges, J.F.; Regnard, Jacques; Lockhart, A

doi:10.1093/bja/63.1.97

Cited by 5 publications

(4 citation statements)

References 28 publications

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“…Morisot et al 16 in 1989 showed that even 50 micrograms of epidural fentanyl caused slight ventilatory depression at one and two hours after its administration and there have indeed been two cases of profound respiratory depression almost certainly due to epidural fentanyl. 17,lS In our study, two patients developed respiratory depression which responded to intravenous naloxone; one Pain NO sympl.…”

Section: Resultsmentioning

confidence: 99%

Does Combined Epidural Lignocaine and Fentanyl Provide Better Anaesthesia for ESWL than Lignocaine Alone?

Cook

1991

Anaesth Intensive Care

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The efficacy of epiduralfentanyl combined with lignocaine 1.5% with adrenaline 1:200,000 was studied in a randomised, double-blind, controlled trial of two hundred patients undergoing extracorporeal shock wave lithotripsy with or without ancillary procedures. The quality of anaesthesia was assessed using linear analogue pain scores, the patient's impression, and the rate of intra-operative intervention by the anaesthetist. Postoperative symptomatology was also recorded. The only significant difference lay postoperatively in that the fentanyl-ancillary procedure subgroup had less pain approximately one hour postoperatively (P = 0.01).

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Section: Resultsmentioning

confidence: 99%

Does Combined Epidural Lignocaine and Fentanyl Provide Better Anaesthesia for ESWL than Lignocaine Alone?

Cook

1991

Anaesth Intensive Care

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“…Morisot and colleagues [3] reported that extradural fentanyl combined with lignocaine produced a significant reduction in the ventilatory response to carbon dioxide. The difference between their results and the present study may be caused by different measurement times and different drugs.…”

Section: Discussionmentioning

confidence: 99%

“…Continuous infusion of opioids and local anaesthetics is now a popular method for pain management [1][2][3]. We could not follow the time course of the ventilatory response because of the limited amount of time available before surgery.…”

Section: Discussionmentioning

confidence: 99%

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Interaction of extradural morphine and lignocaine on ventilatory response

Saito¹,

Sakura²,

Kaneko³

et al. 1995

British Journal of Anaesthesia

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We have evaluated the effects of lumbar extradural morphine and lignocaine on the ventilatory response to carbon dioxide. Twenty-four female patients were allocated randomly to receive extradural morphine 2 mg (group M), 2% lignocaine 10 ml (group L) or a combination of morphine 2 mg and 2% lignocaine 10 ml (group ML). On the day before surgery, resting ventilatory values including minute volume (VE) and tidal volume (VT), and ventilatory response to progressive hyperoxic hypercapnia (VE/PE'CO2) were measured. On the day of surgery, the same measurements were repeated 30 min after extradural injection. Ventilatory values at rest were not altered after extradural injection. Mean VE/PE'CO2 decreased significantly after extradural morphine (P = 0.002) and increased (P = 0.011) after extradural lignocaine. Mean VE 7.3 (VE at PE'CO2 7.3 kPa) decreased significantly after extradural morphine (P < 0.001) and increased after extradural lignocaine (P = 0.047). Extradural morphine and lignocaine did not significantly alter mean VE/PE'CO2 and mean VE 7.3: 14.6 (95% confidence intervals 12.1-17.1) to 15.3 (13.1-17.6) litre min-1 kPa-1 and 22.8 (18.1-27.5) to 22.8 (17.3-28.3) litre min-1, respectively. We conclude that extradural co-administration of morphine and lignocaine did not increase the risk of respiratory depression associated with morphine.

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Fentanyl: Clinical use as postoperative analgesic—Epidural/intrathecal rout

Grass

1992

Journal of Pain and Symptom Management

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The administration of epidural and intrathecal opioids for the management of postoperative pain is well established. Fentanyl, because of its greater lipophilicity, offers a number of advantages over morphine for epidural analgesia, including a lower incidence of side effects and reduced risk of delayed-onset respiratory depression. The relatively short duration of action of epidural fentanyl makes this agent more ideally suited for continuous infusion or patient-controlled epidural analgesia (PCEA). The effective doses and adverse effects profile of epidural fentanyl are reasonably well understood. Because of the lack of spread through the cerebrospinal fluid (CSF) and hence the segmental nature of the analgesia achieved, location of epidural catheter placement is of paramount importance when this agent is used. Prolonged epidural infusion of fentanyl may result in high systemic concentrations not dissimilar to IV infusion, and, therefore, the greatest efficacy of epidural fentanyl administration may be in combination with low concentrations of bupivacaine, an approach that achieves a synergistic effect. 2-Chloroprocaine has been shown to antagonize epidural fentanyl analgesia. Intrathecal fentanyl for postoperative analgesia is limited by its short duration of action with single-bolus administration. The widespread international increase in the use of epidural fentanyl for postoperative analgesia promises further improvements and refinement in techniques.

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Ventilatory Response to Carbon Dioxide During Extradural Anaesthesia With Lignocaine and Fentanyl

Cited by 5 publications

References 28 publications

Does Combined Epidural Lignocaine and Fentanyl Provide Better Anaesthesia for ESWL than Lignocaine Alone?

Does Combined Epidural Lignocaine and Fentanyl Provide Better Anaesthesia for ESWL than Lignocaine Alone?

Interaction of extradural morphine and lignocaine on ventilatory response

Fentanyl: Clinical use as postoperative analgesic—Epidural/intrathecal rout

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