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PubMed1989

[Effects of fentanyl on left ventricular diastolic function].

Effects of fentanyl on left ventricular diastolic function were investigated in chronically instrumented dogs. An electromagnetic mitral flow probe was placed in the left atrium and a micromanometer was placed in the left atrium as well as in the left ventricle to measure ventricular pressure (LVP), left atrial pressure (LAP), derivative of left ventricular pressure (dp/dt), mitral flow (MIF) and ECG in conscious resting dogs. Following induction of anesthesia with thiopental (15-20 mg.kg-1) and vecuronium (0.1 mg.kg-1), fentanyl (10, 50 and 100 mcg.kg-1) was administered at 30 min intervals. The direct measurement of phasic MIF was used to obtain a set of diastolic indices: peak rapid filling period (PRFR), filling volume (FV), FV due to atrial contraction (FV-A), isovolumic relaxation period (IVRP) and diastolic filling period (DFP). Each diastolic index during conscious resting state was compared with that obtained during fentanyl anesthesia using paired t-test. There were no significant changes in those diastolic indices under fentanyl (10, 50 and 100 mcg.kg-1) anesthesia except PRFR and dp/dt under fentanyl 10 mcg.kg-1 which decreased. Although heart rate decreased about 50% under fentanyl, IVRP and PRFR did not increase significantly, but DFP (P less than 0.05) and FV (P less than 0.01) increased significantly. DFP correlated well with RR interval under conscious resting state under fentanyl anesthesia (r = 0.992 and r = 0.967). This study suggests that in the absence of surgical stress, fentanyl does not impair left ventricular diastolic function.

Animals↗
PubMed1989

[The effect of nifedipine and fentanyl on changes in the circulatory reaction to endotracheal intubation].

UNLABELLED: Recommendations for prevention of hypertension and tachycardia during the induction of anesthesia include the use of fentanyl and antihypertensive drugs and superficial anesthesia of the throat. Nifedipine has been used to treat acute hypertension and in many cases it has proved superior to other antihypertensive drugs. The present study was designed to find whether prophylactic injection of nifedipine alone or in combination with fentanyl can prevent cardiovascular responses during endotracheal intubation. METHODS: A total of 140 female patients (ASA groups I or II) with no history of arterial hypertension were randomly allocated to 7 groups: group K was the control group, in which patients received only saline solution; patients in groups 0,1F; 0,2F; 0,3F received 0.1, 0.2 or 0.3 mg fentanyl, respectively; those in group 1,0N, 1 mg nifedipine; those in group 0,5N + 0,1F, 0.5 mg nifedipine, plus 0.1 mg fentanyl; and those in group 1,0N + 0,1F 1 mg nifedipine plus 0.1 mg fentanyl. Blood pressure and heart rate were measured at 1 min intervals. After estimation of control values the prophylactic drug or combination of drugs was injected. Anesthesia was induced in the conventional manner. Plasma concentrations of epinephrine and norepinephrine were analyzed before intubation and at 5, 30 and 60 min intervals after intubation. Side-effects, especially respiratory depression and arrhythmia, were carefully recorded. RESULTS: In group K only systolic BP increased significantly after intubation. In the other groups the peak systolic blood pressure was not statistically different from the preinjection values. Diastolic BP increased significantly after intubation in all but two groups: in group 0,3F and in group 1,0N + 0,1F there was no significant difference in diastolic BP compared with the control values. The heart rate increased significantly in the control group after intubation as well as in groups 0,1F and 0,2F. In patients receiving 0.3 mg fentanyl there was no change in HR after intubation. Administration of 1 mg nifedipine alone (group 1,0N) or in combination with 0.1 mg fentanyl (group 1,0N + 0,1F) caused tachycardia even before intubation, whereas the combination of 0.5 mg nifedipine and 0.1 mg fentanyl did not result in a significant increase of HR following intubation. In all groups, epinephrine concentrations were significantly lower 5 min after intubation. A return to the control values was observed after 60 min in all groups except group 0,1F. Serum concentrations of norepinephrine were lower 5 min after intubation in all groups and were still low in groups 0,1F , 0,2F, 0,5N+0,1F and 1,0N+0,1F up to 60 min after intubation. Side-effects and adverse effects were checked for in the present study. An increase in heart rate was observed during induction in almost every group. More pronounced changes were recorded in groups 1,0N and 1,0N+ 0,1F receiving 1 mg nifedipine.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1986

A comparison of morphine, fentanyl, and sufentanil anesthesia for cardiac surgery: induction, emergence, and extubation.

We compared anesthetic doses of three popular opiates, morphine (n = 10), fentanyl (n = 9), and sufentanil (n = 9) in patients undergoing cardiac surgery. Opiate administration after induction was based upon EEG and cardiovascular signs of the depth of anesthesia. Total doses were morphine, 4.4 +/- 0.71 mg/kg, fentanyl, 95.4 +/- 9.9 micrograms/kg, and sufentanil, 18.9 +/- 2.2 micrograms/kg. Comparisons among opiates included times for induction of anesthesia, return of consciousness, return of spontaneous ventilation, return of adequate cardiovascular status, and extubation. The following times (mean and SEM) were significantly (P less than 0.05) shorter for sufentanil than for fentanyl or morphine: induction (15 +/- 2.3 min, 5.9 +/- 0.7 min, and 3.0 +/- 0.2 min for morphine, fentanyl, and sufentanil, respectively); return of consciousness (morphine 109.7 +/- 34.4 min, fentanyl 62.3 +/- 17.9 min, sufentanil 17 +/- 8.7 min); return of acceptable and stable cardiovascular status (morphine 587.3 +/- 139.3 min, fentanyl 537.9 +/- 144.8 min, sufentanil 173.7 +/- 56.8 min); and extubation (morphine 1121.3 +/- 61.8 min, fentanyl 1005.7 +/- 77.7 min, sufentanil 533.3 +/- 67.8 min). We conclude that sufentanil administered in the dosage range of 19 micrograms/kg allows more rapid induction, earlier emergence from anesthesia, and faster extubation of patients than either morphine or fentanyl.

Adult↗
PubMed1978

[Plasma concentration of fentanyl during and after its administration at constant flow].

Using the technique of the radio-immunological estimation with fentanyl-H3, a study was made in sixteen adults anaesthetised by the administration at a constant rate of alfadione and fentanyl, of plasma concentrations of fentanyl during and after anaesthesia. Anaesthesia was induced by the administration of 4.2ml of alfadione and 0.084mg of fentanyl. The maintenance dose was 0.147 ml/kg/hour of alfadione and 2.95 microgram/hg/hour of fentanyl. Five minutes after induction, the concentration of fentanyl was 2.7 microgram/l. The level fell significantly to 2.56 microgram/l at the 45th minute. From this point onwards, it increased regularly up to the 120th minute, when it reached a level of 3.7 microgram/l. When the infusion was stopped, the level first decreased rapidly, the excretion curve then becoming flattened out. At the 120th minute, a level of 1 microgram/l persisted. This study indicates that the administration of fentanyl at a constant rate is not accompanied by a constant blood concentration up to the 120th minute, the point at which the study was terminated. The residual level found after administration and in the absence of any clinical effect implies the need for a reduction in dose at the time of any complementary administration of fentanyl during the postoperative period.

Adult↗
PubMed1988

Continuous infusion epidural analgesia during labor: a randomized, double-blind comparison of 0.0625% bupivacaine/0.0002% fentanyl versus 0.125% bupivacaine.

The analgesic efficacy of the continuous epidural infusion of 0.0625% bupivacaine/0.0002% fentanyl was compared with the infusion of 0.125% bupivacaine alone in a randomized, double-blind study of nulliparous women. Each patient received, in sequence: 1) 3 ml of 0.5% bupivacaine with 1:200,000 epinephrine; 2) 6 ml of study solution 1 (bupivacaine-fentanyl group: 0.125% bupivacaine/0.0008% fentanyl; bupivacaine-only group: 0.25% bupivacaine alone); and 3) a continuous epidural infusion of study solution 2 at a rate of 12.5 ml/h (bupivacaine-fentanyl group: 0.0625% bupivacaine/0.0002% fentanyl; bupivacaine-only group: 0.125% bupivacaine alone). The epidural infusion was discontinued at full cervical dilatation, but patients who lacked perineal anesthesia received one or two 5-ml boluses of study solution 3 (bupivacaine-fentanyl group: 0.0625% bupivacaine alone; bupivacaine-only group: 0.125% bupivacaine alone). During the first stage of labor, 36 of 41 (88%) women in the bupivacaine-fentanyl group, and 37 of 39 (95%) women in the bupivacaine-only group, had analgesia of excellent or good quality (P = NS). During the second stage, 22 of 37 (59%) women in the bupivacaine-fentanyl group, and 23 of 35 (66%) women in the bupivacaine-only group, rated their analgesia as excellent or good (P = NS). Women in the bupivacaine-only group were more likely to have motor block at full cervical dilatation (P less than .001). There was no significant difference between groups in duration of the second stage of labor, duration of pushing, position of the vertex before delivery, method of delivery, Apgar scores, or umbilical cord blood gas and acid-base values.(ABSTRACT TRUNCATED AT 250 WORDS)

Analgesia↗
PubMed1988

Balanced anesthesia and patient-controlled postoperative analgesia with fentanyl: minimum effective concentrations, accumulation and acute tolerance.

Minimum effective fentanyl concentrations (MEC) were determined in 230 ASA I-III patients undergoing a variety of elective surgical procedures under balanced anesthesia, and in 40 patients recovering from comparable operations and anesthesia during postoperative intravenous self-administration of fentanyl (demand dose 34.5 micrograms) by means of the On-Demand Analgesia Computer. Following induction of anesthesia with fentanyl 4 micrograms/kg, repetitive fentanyl reinjections (0.1-0.2 mg) were given intraoperatively whenever systolic blood pressure or pulse rate increased to more than 20% of preinduction values, resulting in an intraoperative fentanyl consumption of 4.2 +/- 1.2 micrograms/kg/h. Duration of postoperative patient-controlled analgesia (PCA) was 20.2 +/- 4.3 h during which time 15.5 +/- 12.9 demands per patient were registered, resulting in a postoperative fentanyl consumption of 0.46 +/- 0.35 micrograms/kg/h. MECs appeared to be log-normally distributed (intra-operative median 2.6 ng/ml, range 0.2-36.6; postoperative median 1.2 ng/ml, range 0.2-8.0). Mean intra- and interindividual variability in MEC was 37% intraoperatively or 27% postoperatively, and 68% or 63%, respectively. There was no obvious correlation between postoperative fentanyl consumption or individual mean MEC and analgesic efficacy, which was generally described as superior to conventional pain treatment. Individual MECs increased gradually during anesthesia (mean slope 0.0191 ng/ml/min) but decreased under PCA conditions (-0.0008 ng/ml/min); difference not significant. While the postoperative decrease could be explained by diminishing pain intensity during the observation period, the slight intraoperative increase is discussed as acute tolerance rather than as accumulation. It is concluded that repetitive fentanyl injections as indicated by clinical needs will not lead to relevant accumulation in serum, and that analgesic therapy should be individualized both intra- and postoperatively.

Adult↗
PubMed1987

Low-dose enflurane as adjunct to high-dose fentanyl in patients undergoing coronary artery surgery: stable hemodynamics and maintained myocardial oxygen balance.

The effects of enflurane (end-tidal concentration 0.7%) on central and coronary hemodynamics and myocardial oxygenation were studied during steady state, high-dose fentanyl anesthesia in ten patients undergoing coronary artery bypass grafting operations. Compared with the response in ten patients receiving the same fentanyl anesthesia (100 micrograms/kg) without enflurane supplementation, enflurane caused a moderate reduction in mean arterial pressure, systemic vascular resistance, and left ventricular stroke work index. No patient showed signs of myocardial ischemia, and mean coronary sinus flow and calculated coronary resistance remained unchanged. Surgical stimulation induced no central or coronary hemodynamic responses in the enflurane-fentanyl group. No coronary hemodynamic changes occurred in the fentanyl group, but a marked increase in arterial pressure and systemic vascular resistance was seen. Myocardial oxygen extraction decreased in the enflurane supplemented group although it increased in the fentanyl group after surgical stimulation. Three fentanyl group patients and one enflurane-fentanyl group patient had a low myocardial lactate extraction as a sign of myocardial ischemia during surgery. We conclude that a 0.7% enflurane supplementation of 100 micrograms/kg fentanyl anesthesia does not endanger myocardial oxygenation and effectively prevents central and coronary hemodynamic responses to skin incision and sternotomy in patients undergoing coronary artery surgery.

Anesthesia, General↗
PubMed1984

Effects of fentanyl and nitrous oxide on contractility of blood-perfused papillary muscle of the dog.

The effects of fentanyl, nitrous oxide, and their combination on myocardial contractility were investigated in the papillary muscle preparation perfused by a donor dog. With a conscious donor, fentanyl infused directly into the arterial blood perfusing the papillary muscle produced a dose-related depression of developed tension. However, blood concentrations of fentanyl required to obtain the depression were in the range of 30-120 micrograms/ml. The ED50 for fentanyl for suppression of papillary muscle contractility was 89 +/- 9 micrograms/ml. When the donor dog was given nitrous oxide (N2O,80% and O2,20%), the developed tension of the papillary muscle decreased 25 +/- 5%. Fentanyl administered during nitrous oxide anesthesia caused a decrease in developed tension that was not significantly different from that obtained without N2O anesthesia (18 +/- 4% vs 13 +/- 4% for 30 micrograms/ml, and 61 +/- 5% vs 58 +/- 4% for 100 micrograms/ml). The results suggest that fentanyl produces a direct negative inotropic effect only in concentrations that are 2-3 orders of magnitude higher than its blood concentrations in fentanyl-induced anesthesia. When fentanyl and nitrous oxide are used together their interaction is not significantly different from additive.

Animals↗
PubMed1978

[Respiratory depression after fentanyl and antagonism by naloxone (author's transl)].

The postoperative respiratory depressant effect of fentanyl in combination with flunitrazepam (Rohypnol) was assessed in awake and in unconscious patients. In awake patients respiratory function was measured with blood-gas analyses. For measurements in unconscious patients the administration of nitrous oxide/oxygen was continued postoperatively and the respiratory depression was judged from the increase in respiratory minute volume after the i.v. administration of 0.05 mg naloxone (Narcan). In the group of awake patients blood-gasvalues were within the normal range after anaesthesia with flunitrazepam (1 mg) and fentanyl (0.80 mcg/kg body weight/10 min anaesthesia; last fentanyl given 40 min before the end of the operation), and the administration of naloxone was without any effect. If, however, naloxone was given while the patients were kept under light nitrous oxide/oxygen anaesthesia, the effect was different. The respiratory minute volume was considerably less than its predicted value in all groups of patients having received fentanyl, and naloxone caused a marked increase in respiratory minute volume and in respiratory rate. In a group of patients which have received no opiate but enflurane, naloxone showed no effect. After premedication with pethidine as compared with flunitrazepam the effect of naloxone on ventilation was more pronounced. This marked difference in the postoperative effect of fentanyl on ventilation depending on the state of consciousness has to be attributed to an interaction between a residual respiratory depressant effect of fentanyl and the effect of unconsciousness. Since after the combined use of flunitrazepam and fentanyl deep postoperative sleep occurs quite frequent, a residual effect of fentanyl should always be antagonized with naloxone to protect the patients from a possible hazardous effect of this interaction.

Adolescent↗
PubMed1981

Oxygen-high dose fentanyl-droperidol anesthesia for aortocoronary bypass surgery.

Ten patients undergoing aortocoronary bupass surgery were studied during induction of anesthesia and during initial surgical stimulation. Each patient was anesthetized with fentanyl, 100 micrograms/kg, droperidol, 0.15 mg/kg, and pancuronium, 0.1 mg/kg, and ventilated with 100% oxygen. Preoperative medication consisted of propranolol, nitrate preparations, diazepam, 0.15 mg/kg orally, morphine, 0.15 mg/kg IM, and scopolamine, 0.4 mg IM. Intravenous, arterial, and Swan-Ganz catheters were inserted under local anesthesia after which control measurements of hemodynamic parameters and arterial blood gas tensions were taken. Observations were repeated after fentanyl, 50 micrograms/kg, after endotracheal intubation, after another dose of fentanyl, 50 micrograms/kg, after skin incision, and after sternotomy. The total dose of droperidol was given incrementally throughtout the fentanyl infusion. Normal saline was infused to maintain constant pulmonary capillary wedge pressure. Heart rate, left ventricular stroke work index, triple index, pulmonary capillary wedge pressure, and PaCO2 remained constant throughout the study. Systolic blood pressure decreased significantly after fentanyl, 50 micrograms/kg, and initial administration of droperidol, but thereafter remained unchanged. Stroke index increased significantly after fentanyl, 50 micrograms/kg, and remained elevated at all subsequent intervals. Cardiac index increased after fentanyl, 50 micrograms/kg and 100 micrograms/kg. Rate-pressure product was stable until the time of sternotomy after which it decreased significantly. In patients undergoing aortocoronary bypass surgery, 100% oxygen, fentanyl, 100 micrograms/kg, and droperidol, 0.15 mg/kg, produced stable hemodynamics during induction, intubation, and sternotomy. Maintenance of pulmonary capillary wedge pressure by volume infusion may have been contributed to this stability.

Anesthesia, Intravenous↗
PubMed1994

[Inhibitory effect of fentanyl citrate on endothelium-dependent relaxation in rat aorta].

We studied the effect of fentanyl on the endothelium-dependent vascular responses in isolated rat aortic strips. Fentanyl depressed the endothelium-dependent relaxation induced by acetylcholine but not that induced by the calcium ionophore, A23187. Endothelium-independent relaxation in response to sodium nitroprusside (SNP), a soluble guanylate cyclase activator, was not depressed by fentanyl. On the other hand, fentanyl depressed the increase in cyclic GMP level stimulated by acetylcholine but not that stimulated by A23187 or SNP. Furthermore, fentanyl depressed the vasocontraction by acetylcholine but not that by histamine or KCl in isolated pig coronary artery strips without endothelium, suggesting that fentanyl can inhibit endothelium-independent contraction via muscarinic receptor on smooth muscle cells. These results suggest that fentanyl can inhibit endothelium-dependent vasorelaxation via endothelium-derived relaxing factor (EDRF) by acting on endothelial cells but not on smooth muscle cells. The inhibitory effect of fentanyl on the relaxation probably occurs at the level of muscarinic receptor on endothelial cells or at a site before biochemical pathways converting L-arginine to EDRF.

Acetylcholine↗
PubMedDate not supplied

PDPH in obstetric anesthesia: comparison of 24-gauge Sprotte and 25-gauge Quincke needles and effect of subarachnoid administration of fentanyl.

BACKGROUND AND OBJECTIVES: Postdural puncture headache (PDPH) is a frequent complication of spinal anesthesia. Some investigators have recommended the use of the Sprotte needle to reduce the incidence of this serious complication. This study prospectively compared the incidence of PDPH with two spinal needles of different size and design: the 24-gauge Sprotte (noncutting point) versus the 25-gauge Quincke (diamond, cutting point). The hypothesis that subarachnoid fentanyl will reduce the incidence of PDPH, as suggested in the literature, was also studied. METHODS: Only patients for emergency or elective cesarean delivery were studied. One hundred ninety four patients were randomly assigned to receive spinal anesthesia with one of the two needles (Sprotte, n = 96; Quincke, n = 98). Simultaneously, each patient was assigned to receive hyperbaric 0.75% bupivacaine local anesthetic or a combination of the same concentration of local anesthetic with 20 micrograms of fentanyl (Sprotte with fentanyl, n = 47; Sprotte without fentanyl, n = 49; Quincke with fentanyl, n = 49; Quincke without fentanyl, n = 49). All patients were evaluated during the first 4 postoperative days, and follow-up telephone interviews were conducted 3 weeks after discharge. RESULTS: Four patients (4.2%) in the Sprotte group and seven (7.1%) in the Quincke group developed PDPH. Three out of four patients with headache in the Sprotte and four out of seven in the Quincke group received fentanyl as an adjunct for spinal anesthesia. Two patients in the Sprotte group required an epidural blood patch as a therapy for PDPH. Two patients in the Quincke group had severe headache and required an epidural blood patch. CONCLUSIONS: In the current study, the use of the 24-gauge Sprotte spinal needle resulted in a low incidence of severe PDPH, but was not significantly different when compared with the use of a 25-gauge Quincke needle (oriented parallel to the longitudinal dural fibers). The addition of fentanyl to hyperbaric bupivacaine spinal anesthesia did not reduce the risk of PDPH.

Adult↗
PubMed1998

Fentanyl and its analogs desensitize the cloned mu opioid receptor.

Fentanyl, and its structural analogs lofentanil and sufentanil, are potent analgesics used clinically in the management of pain. However, the high analgesic potency of these compounds is limited by the development of tolerance after chronic use. To investigate whether their tolerance development may be related to mu receptor desensitization, the cloned mouse mu receptor as well as mutant forms of the receptor were stably expressed in HEK 293 cells and tested for their response to continuous opioid treatment. Fentanyl and its analogs potently bound to the mu receptor and effectively inhibited cAMP accumulation. Three-hour pretreatment of mu receptors with fentanyl and its analogs desensitized the mu receptor by uncoupling it from adenylyl cyclase. The fentanyl analogs caused a slight internalization of the mu receptor as accessed by antibody binding to the epitope-tagged mu receptor. Truncation of the mu receptor by removal of its carboxyl terminus at Glu341 did not affect the ability of the fentanyl analogs to bind to and activate the mu receptor nor did it prevent the fentanyl analogs from desensitizing the receptor. In a previous study we showed that morphine did not desensitize the cloned mu receptor even though it is a potent and effective agonist at the mu receptor. Mutagenesis studies revealed that morphine interacts differently with the mu receptor to activate it than do the fentanyl analogs which may explain its lack of desensitization of the mu receptor. These results indicate that desensitization of the mu receptor may be a molecular basis for the development of tolerance to fentanyl and its analogs.

Analgesics, Opioid↗
PubMed1998

Synergism between sevoflurane and intravenous fentanyl on A delta and C somatosympathetic reflexes in dogs.

UNLABELLED: In this study, we defined the nature of the interactions between sevoflurane and fentanyl on spontaneous and reflex-evoked sympathetic activity, resting heart rate (HR), and mean arterial pressure (MAP). Spontaneous renal sympathetic nerve activity (RSNA) and A delta- and C-fiber-mediated somatosympathetic reflexes, evoked by electrical stimulation of radial nerves, and HR and MAP were recorded in anesthetized dogs. In one group, the effects of incremental doses of 2-64 micrograms/kg fentanyl i.v. were observed. It had a greater inhibitory effect on C than on A delta reflexes, which were abolished by mean cumulative doses of 64 micrograms/kg and approximately 128 micrograms/kg, respectively. Although 1.5% sevoflurane reduced C reflexes by 28% and A delta reflexes by only 12%, it reduced the total doses of fentanyl required for their abolition to 32 micrograms/kg and 64 micrograms/kg, respectively. Mean RSNA, HR, and MAP values were reduced by 46%, 54%, and 30%, respectively, by fentanyl alone and by 23%, 11%, and 17%, respectively, in response to 1.5% sevoflurane. The combination of fentanyl and sevoflurane caused reductions of 44%, 54%, and 41%, respectively, which indicates a less than additive effect. These results indicate that sevoflurane interacts synergistically with fentanyl to depress A delta and C somatosympathetic reflexes, whereas for RSNA, HR, and MAP, their effects were less than the additive. IMPLICATIONS: Although fentanyl caused a greater depression of C than of A delta reflexes to the point of abolition, the maximal depression of spontaneous sympathetic activity, heart rate, and arterial pressure occurred at smaller doses. The combined depressant effects of sevoflurane and fentanyl were synergistic on somatosympathetic reflexes but were less than additive on spontaneous sympathetic activity, heart rate, and arterial pressure.

Analgesics, Opioid↗
PubMed1998

Prospective and randomized trial of intravenous tenoxicam versus fentanyl and tramadol for analgesia in outpatient extracorporeal lithotripsy.

BACKGROUND: As extracorporeal shock wave lithotripsy (ESWL) is frequently carried out on an outpatient basis, it is crucial to choose an adequate analgesic with less adverse effect. This study evaluated the use of three different intravenous agents: fentanyl, tramadol HCl and tenoxicam in ESWL. METHODS: One hundred and twenty patients undergoing lithotripsy were randomly assigned to receive either intravenous fentanyl 1 microgram/kg, tramadol HCl 1.5 mg/kg or tenoxicam 0.3 mg/kg before lithotripsy. Pain intensity was recorded using verbal rating pain scales (VRPS). Cases without adequate analgesia (VRPS > 4) or could not tolerate the pain, additional bolus of fentanyl 25 micrograms were given until adequate analgesia was achieved. Side effects were recorded as well. RESULTS: No significant differences were found among groups in demographic data, VRPS, number of total shock waves, cases with supplementary fentanyl, mean dose of supplementary fentanyl or the incidence of dizziness. However, the incidence of nausea or vomiting was significantly higher in fentanyl and tramadol groups comparing with tenoxicam group (15.0% and 25.0% vs. 0.0%). Oxygen saturation in fentanyl group was also significantly lower than the other two groups (p < 0.01). In addition, VRPS had a significant correlation with voltage intensities (p < 0.05). CONCLUSIONS: Lithotripsy can be satisfactorily performed by employing fentanyl, tramadol or tenoxicam for analgesia; tenoxicam apparently offers a better analgesic quality with less side effect. Furthermore, the need for stronger analgesia during larger voltage intensity should be tailored to the needs of the individuals.

Ambulatory Surgical Procedures↗
PubMed1998

The addition of intrathecal sufentanil and fentanyl to bupivacaine for caesarean section.

AIM OF STUDY: Intrathecal sufentanil has recently been used in labour as part of a combined spinal epidural technique. This study was conducted to compare its use in combination with bupivacaine for caesarean section with fentanyl added to bupivacaine and bupivacaine alone. METHODS: Sixty ASA I and II patients for non-emergency caesarean section under spinal anaesthesia were divided into three groups to receive 15 micrograms fentanyl added to 7.5 mg bupivacaine, 10 micrograms sufentanil added to 7.5 mg bupivacaine and 7.5 mg bupivacaine. Onset time of sensory blockade, side effects, surgical conditions, neonatal outcome and quality of the anaesthetic was assessed. On the first postoperative day, duration of effective analgesia, side effects and patient satisfaction were noted. RESULTS: The duration of effective analgesia of bupivacaine alone was prolonged with the addition of sufentanil and fentanyl by 358% and 256% respectively. No patient in the sufentanil and fentanyl groups required additional intra-operative analgesics compared with 17.6% of patients in the bupivacaine alone group. There was an increase in incidence of desaturation in the sufentanil group (45%) and fentanyl group (5.6%) compared with the bupivacaine only group (0%). The incidence of pruritus was 35% with sufentanil, 27.8% with fentanyl against 0% with bupivacaine alone. CONCLUSION: The addition of 10 micrograms of sufentanil and 15 micrograms of fentanyl to 7.5 mg of bupivacaine prolonged the duration of effective analgesia and improved intra-operative analgesia. However, the incidence of pruritus and episodes of desaturation were increased more with 10 micrograms sufentanil than with 15 micrograms fentanyl.

Adult↗
PubMed1999

[Switching opioids to transdermal fentanyl in a clinical setting].

INTRODUCTION: The use of transdermal fentanyl is gaining in importance in the management of cancer pain. We describe the reasons for switching opioid medication to transdermal fentanyl in a pain management unit. METHODS: Case records of patients treated with transdermal fentanyl in our pain clinic were evaluated retrospectively. Conversion ratios were calculated from the opioid dosage before and after conversion. Pain intensities were assessed on a numeric rating scale (NRS 0: no pain, 10: worst pain imaginable). RESULTS: From October 1995 to December 1997 101 patients received transdermal fentanyl. Thirty-six patients had been treated with transdermal fentanyl before admission to our pain clinic, and relevant information was missing for one patient, so 64 patients were evaluated. Opioid therapy was switched to transdermal fentanyl during in-patient treatment for 53 patients and during out-patient treatment for 11 patients. Before conversion patients were treated with slow-release morphine (48%), immediate-release morphine (17%), buprenorphine (11%), tramadol (11%), levomethadone (5%), tilidine/naloxone (5%) and piritramid (3%). Reasons for opioid rotation were inadequate pain relief ( 33%), the patients' wish to reduce oral medication (20%), gastrointestinal side effects such as nausea (31%), vomiting (13%) and constipation (19%), dysphagia (27%) or others. Reduction of side effects was reported by 10 of 19 patients. In 12 of 21 patients, in whom the medication was switched because of inadequate pain relief, a reduction in pain intensity was reported. DISCUSSION: Conversion to transdermal therapy may readjust the balance between opioid analgesia and side effects. The opioid switch resulted in more pain relief or fewer side effects in half of the patients. A proposed equianalgesic conversion ratio between 70:1 and 100:1 from oral slow-release morphine to transdermal fentanyl can be confirmed by our data. Conversion rates from other opioids to transdermal fentanyl are suggested.

English Abstract↗
PubMed1993

Maternal effects of adding epidural fentanyl to 0.5% bupivacaine for caesarean section.

Epidural injection of fentanyl added to 0.5% bupivacaine improves epidural anaesthesia during caesarean section. The present prospective randomized double-blind study sought to determine the lowest effective dose of fentanyl. Eighty healthy women at term were divided into four groups of 20, with each group receiving a different 2 ml study solution: saline (control) or 50, 75 or 100 microg of fentanyl added to 20 ml of 0.5% bupivacaine. Additional increments of 0.5% bupivacaine were administered as required at 30 min and onwards until a bilateral block to T4 was attained. The onset, duration and segmental level of analgesia, and degree and duration of motor block were not influenced by the addition of fentanyl. Peroperative quality of analgesia was improved, as the request for supplementary analgesics was less following the addition of 75 or 100 microg of fentanyl (P < 0.05). Postoperatively the time to first supplemental opioid request was prolonged and pain was reduced for at least 6 h from induction of anaesthesia when 75 or 100 microg of fentanyl had been added (P < 0.05). Pruritus was the only side-effect (P < 0.05). In conclusion, fentanyl 75 microg was the lowest effective dose for improving quality of analgesia. Onset time was not reduced by the addition of fentanyl.

Journal Article↗