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At least 37 records · Page 2Linked to original sources

PubMed2001

The influence of a bupivacaine and fentanyl epidural infusion after epidural fentanyl in patients allowed to ambulate in early labor.

UNLABELLED: Epidural fentanyl after a lidocaine and epinephrine test dose provides adequate analgesia and allows for ambulation during early labor. This study was designed to determine the influence of an epidural infusion of bupivacaine plus fentanyl administered after initiation of epidural labor analgesia with fentanyl. Specifically, we evaluated whether there is an increase in motor block or an increased time to request for further analgesic medication. Fifty-one laboring primigravid women at <5 cm cervical dilation who requested epidural analgesia were enrolled. After a 3-mL epidural test dose of 1.5% lidocaine with epinephrine (5 microg/mL), patients received fentanyl 100 microg via the epidural catheter. They then randomly received either an infusion (10 mL/h) of 0.0625% bupivacaine with fentanyl (3 microg/mL) or an infusion of preservative-free saline. After the administration of the initial analgesic, pain scores and side effects were recorded for each patient at 10, 20, and 30 min, every 30 min thereafter, and at the time of request for additional analgesic medication, by an observer blinded to the technique used. There were no demographic differences between the two groups. The mean duration of analgesia (time from initial dose to request for additional analgesia) was increased in the group that received a continuous infusion of bupivacaine and fentanyl compared with the Saline group (198 +/- 86 vs 145 +/- 50 min; P < 0.009). Side effects were similar between the two groups. No patient in either group experienced any detectable motor block. Fourteen patients chose to ambulate in the Saline group, and 12 patients chose to ambulate in the Infusion group. In early laboring patients, a continuous infusion of 0.0625% bupivacaine infusion with fentanyl (3 microg/mL) prolonged the duration until top-up was required, after epidural fentanyl 100 microg after a lidocaine and epinephrine test dose, and did not cause any clinically detectable motor block. IMPLICATIONS: A 0.0625% bupivacaine and fentanyl (3 microg/mL) infusion, when added to epidural fentanyl (100 microg), prolongs the analgesic duration without increasing motor block in women in early labor.

Adjuvants, Anesthesia↗

PubMed1993

Patient-controlled extradural analgesia to compare bupivacaine, fentanyl and bupivacaine with fentanyl in the treatment of postoperative pain.

We have assessed the effect of combining extradural bupivacaine and fentanyl in 60 orthopaedic patients who received 0.125% bupivacaine (bupivacaine group), fentanyl 5 micrograms ml-1 (fentanyl group), or 0.125% bupivacaine combined with fentanyl 5 micrograms ml-1 (combined group), delivered by patient-controlled extradural analgesia for 24 h via a lumbar extradural catheter. Adding bupivacaine to fentanyl reduced mean (SD) fentanyl administration from 117 (46) ml to 89 (42) ml (P < 0.005). Adding fentanyl to bupivacaine reduced mean bupivacaine administration from 113 (46) ml to 89 (42) ml (P < 0.05). There was no significant difference between the groups in pain, nausea, motor block, pruritus or sedation. No patient had a ventilatory frequency less than 10 b.p.m. Hypotension (systolic AP < 100 mm Hg) occurred in two of 20 patients in the fentanyl group, compared with eight of 19 in the bupivacaine group and 10 of 21 in the combined group. The mean total volume of extradural solution administered was greater after knee replacement (126 (46) ml) than after hip replacement (84 (35) ml) (P < 0.001). The mean pain score was greater also for knee replacement (16 (10) mm) than for hip replacement (10 (9) mm) (P < 0.05). We conclude that extradural bupivacaine and fentanyl were additive in their analgesic actions, resulting in decreased requirements of each individual agent. Knee replacement was found also to be more painful than hip replacement after operation.

Adult↗

PubMedDate not supplied

Evaluation of the Coat-A-Count 125I fentanyl RIA: comparison of 125I RIA and GC/MS-SIM for quantification of fentanyl in case urine specimens.

The Coat-A-Count solid phase 125I Fentanyl Radioimmunoassay was evaluated with respect to linearity and precision using equine urine fortified with fentanyl and then compared with a gas chromatographic/mass spectrometric method for quantification of fentanyl in urine. The RIA assay was found to be linear over the urine fentanyl concentration range of 0.25 to 7.5 ng/mL and precise with coefficients of variation (CV) ranging from 9.6 to 19.3%. The RIA calibrators, ranging in fentanyl concentrations from 0.25 to 7.5 ng/mL, and controls, at mean fentanyl concentrations of 0.46 and 1.32 ng/mL, were compared by both the RIA and GC/MS methods. The cross-reactivity with the 125I RIA test was determined for the fentanyl metabolites, norfentanyl and hydroxyfentanyl, and found to be 5% and 35%, respectively. The illicit fentanyl analogs were found to show significant cross-reactivity, ranging from 20 to 100%. The 125I RIA was compared to GC/MS quantifications of fentanyl in 35 positive and 20 negative case urine specimens.

Cross Reactions↗

PubMedDate not supplied

Fentanyl receptor assay. II. Utilization of a radioreceptor assay for the analysis of fentanyl analogs in urine.

A radioreceptor assay has been developed to measure fentanyl and fentanyl-like drugs in biological specimens. The assay is based on the competition of these drugs with [3H]fentanyl for opioid receptors. Rats were injected intravenously with fentanyl (15 micrograms/kg), alpha-methylfentanyl (15 micrograms/kg), (+/-)-cis-3-methylfentanyl (15 micrograms/kg), butyrylfentanyl (0.48 mg/kg), and benzylfentanyl (3.19 mg/kg). Urine samples were analyzed by radioreceptor assay (RRA), radioimmunoassay (RIA), and gas chromatography/mass spectrometry (GC/MS). The time-course of urinary analysis of fentanyl analogs showed some discrepancies. RRA measurement of urine concentrations of (+/-)-cis-3-methylfentanyl that were undetectable by RIA gave results 5-10 times higher than values obtained by GC/MS. Concentrations of alpha-methylfentanyl obtained by RRA and GC/MS were similar; however, these samples were negative by RIA. Following the administration of benzylfentanyl, urinary concentrations were not detected by RIA and only slightly detectable with RRA; however, high concentrations of benzylfentanyl were found by GC/MS in the same samples. Urine samples from animals injected with butyrylfentanyl showed high cross-reactivity with fentanyl antibody, giving values measured by radioimmunoassay about two times higher than those obtained by the other two methods. These findings suggest that this radioreceptor assay is well-suited as an initial assay for the detection of active analogs of fentanyl in urine and correlates well with other techniques in the analysis of fentanyl; however, there is substantial disagreement between techniques in the quantitation of fentanyl analogs.

Analgesics↗

PubMed2004

Fatal intravenous fentanyl abuse: four cases involving extraction of fentanyl from transdermal patches.

The transdermal fentanyl system delivers a specific dose at a constant rate. Even after the prescribed application time has elapsed, enough fentanyl remains within a patch to provide a potentially lethal dose. Death due to the intravenous injection of fentanyl extracted from transdermal patches has not been previously reported. We present 4 cases in which the source of fentanyl was transdermal patches and was injected. In all of these cases, the victim was a white male who died at home. Case 1 was a 35-year-old with no known history of drug use, who was found by his wife on the floor of his workshop. Police recovered a fentanyl patch, needle, and syringe at the scene. Case 2 was a 38-year-old with a known history of drug use whose family claimed that he was in a treatment program that used fentanyl patches for unknown reasons. His brother found him dead in bed, and law enforcement officers found a hypodermic needle beside the body; a ligature around his left hand, and apparent needle marks between his first and second digits were also noted. Case 3 was a 42-year-old with a recent attempted suicide via overdose who was found dead at his home. An empty box of fentanyl patches, Valium, Ritalin, and 2 syringes were found at the scene. Case 4 was a 39-year-old found by his mother, who admitted to removing a needle with attached syringe from the decedent's arm. Medications at the scene included hydrocodone, alprazolam, zolpidem, and fentanyl patches. All reported deaths were attributed to fentanyl intoxication, with blood concentrations ranging from 5 to 27 microg/L.

Administration, Cutaneous↗

PubMed2003

A small preoperative test dose of intravenous fentanyl can predict subsequent analgesic efficacy and incidence of side effects in patients due to receive epidural fentanyl.

UNLABELLED: Because individual variation is a likely factor affecting both the incidence and severity of side effects and the analgesic efficacy of epidural opioids, assessment of individual variation could be useful in deciding optimal dosage. By evaluating the response to a small test dose of IV fentanyl, we designed this study to predict the degree of pain relief and the incidence of side effects in patients who would be receiving postoperative epidural fentanyl. Before the induction of anesthesia, 50 micro g of fentanyl was administered IV, and 2 min after fentanyl, the patient response was evaluated. Twenty-three patients, who reported nausea, sleepiness, dizziness, sensation of warmth, and other symptoms, were categorized as responders (Group R); the remaining 20 patients were categorized as nonresponders (Group NR). At the completion of surgery, infusion of epidural fentanyl was administered (0.3 mg/d in 0.25% bupivacaine) for 96 h. At postoperative Hours 6 and 24, Group R had significantly lower visual analog scale scores for postoperative pain intensity and required fewer analgesics than Group NR. The incidence of side effects, however, was 74% for Group R and 10% for Group NR (P < 0.05), and side effects were more serious in Group R. This study demonstrates that preoperative administration of a small dose of fentanyl during the induction of anesthesia enables prediction of the analgesic efficacy of postoperative epidural fentanyl and the incidence and severity of side effects. IMPLICATIONS: Preoperative administration of a small dose of fentanyl during the induction of anesthesia enables prediction of the analgesic efficacy of postoperative epidural fentanyl and the incidence and severity of side effects.

Aged↗

PubMed1983

Blood pressure response and plasma fentanyl concentrations during high- and very high-dose fentanyl anesthesia for coronary artery surgery.

We examined whether different plasma fentanyl concentrations could maintain hemodynamic stability during coronary artery surgery. Two randomly selected groups of 10 patients were studied. Patients in group 1 received a single 75-micrograms/kg intravenous dose of fentanyl; patients in group 2 received the same dose but it was followed by an infusion of fentanyl at a rate of 0.75 micrograms/kg/min. The total dose of fentanyl in group 2 was 162 +/- 6.5 micrograms/kg (mean +/- SEM). At some point during surgery, all 10 patients in group 1 and 7 of 10 patients in group 2 had a hypertensive response. Plasma fentanyl concentrations in the two groups were not significantly different in the period 10-45 min after induction of anesthesia. At 60 min, corresponding to the time of aortic root dissection, mean plasma fentanyl concentration was statistically significantly lower in group 1 than in group 2 (13.5 +/- 1.4 ng/ml and 24 +/- 2.3 ng/ml, respectively, P less than 0.01). However, no significant difference was observed in the frequency of hypertensive response between the two groups in the period before cardiopulmonary bypass. During cardiopulmonary bypass, plasma fentanyl concentrations in group 1 were 2-3 times lower than those in group 2, and hypertension was observed in all 10 patients in group 1 but in only 2 patients in group 2 (P less than 0.05). Patients in group 1 were ventilated for 16.6 +/- 1.5 h, and those in group 2 for 19.1 +/- 1.8 h, postoperatively (P greater than 0.05). Six patients in group 1 required vasodilating drugs, whereas eight patients in group 2 required alpha-adrenergic agonists. Although the plasma fentanyl concentrations achieved were not successful in totally suppressing a hypertensive response, this study suggests that a plasma fentanyl concentration might be attainable to effect this.

Anesthesia, Intravenous↗

PubMed1999

Intraoperative high dose fentanyl induces postoperative fentanyl tolerance.

PURPOSE: In a randomized, double-blind clinical trial, we compared the postoperative analgesic effect and dose consumption of fentanyl after intraoperative high dose and low dose fentanyl administration. METHODS: Sixty ASA class I to II female patients undergoing total abdominal hysterectomy (TAH), were randomly allocated to receive either 1 microg x kg(-1) (low dose group, n = 30) or 15 microg x kg(-1) (high dose group, n = 30) fentanyl during induction of anesthesia. Anesthesia depth was maintained with inhalation of halothane in the low dose group, or combined with 100 microg x hr(-1) fentanyl i.v. in the high dose group. Postoperative pain was treated with an intravenous patient-controlled analgesia system and was assessed with a visual analog pain score at rest. RESULTS: Patients in the high dose group had higher pain intensity at four and eight hours postoperatively, more fentanyl consumption and a greater incidence of emesis in the postoperative period of 16 hr than those in the low dose group (P < 0.05). Heart rate, blood pressure, and respiratory rate were similar between the two groups. CONCLUSION: Our results suggest that acute fentanyl tolerance develops after administration of high dose fentanyl during surgery and, consequently, results in a higher postoperative pain intensity and greater fentanyl consumption.

Analgesics, Opioid↗

PubMed1999

Development and validation of an HPLC assay for fentanyl and related substances in fentanyl citrate injection, USP.

The stability indicating properties of the USP method for the assay of fentanyl in fentanyl citrate injection were evaluated [1] by analyzing fentanyl drug substance and product after acid, hydrogen peroxide, heat, and light treatment. N-phenyl-N-(4-piperidinyl)propionamide (PPA), which is a known degradation product/process impurity of fentanyl, was not adequately resolved from the fentanyl peak, and mobile phase adjustments did not improve the resolution (Fig. 1). Therefore, the USP method did not meet the requirements for a stability-indicating assay. In addition, the wavelength in the USP method was too high (230 nm) to provide adequate levels for the quantitation of the related substances of fentanyl and, in addition, the acetate ions in the mobile phase could interfere with a lower wavelength detection. An isocratic, reversed phase, stability indicating, high performance liquid chromatographic (HPLC) method for the assay of fentanyl and related substances in fentanyl citrate injection, USP has been developed and validated. The chromatographic conditions employed an Inertsil C8, 5 column (25 cm x 4.6 mm), a mobile phase of aqueous perchloric acid [0.23%, w/v]-acetonitrile [65:35, v/v], and ultraviolet (UV) detection at 206 nm. Under the chromatographic conditions of the method, PPA and seven other known process impurities were separated from the active. Degradation studies showed that the active eluted as a spectrally pure peak resolved from its degradation products.

Chromatography, High Pressure Liquid↗

PubMed1991

Adrenaline, fentanyl or adrenaline and fentanyl as adjuncts to bupivacaine for extradural anaesthesia in elective caesarean section.

We have compared the effects of extradural fentanyl and fentanyl plus adrenaline with adrenaline alone as adjuncts to extradural bupivacaine in patients undergoing elective Caesarean section. Forty-five patients were allocated randomly to receive 0.45% bupivacaine 20 ml with adrenaline 4.5 micrograms ml-1, fentanyl 4.5 micrograms ml-1 or adrenaline plus fentanyl (4.5 micrograms ml-1 of each) as supplements. The main outcome measures were time to bilateral analgesia of T6 or higher, need for intraoperative analgesic supplements, observer rating of intraoperative analgesia and patient assessment of analgesia using a 10-cm visual analogue scale. The time to onset of analgesia to T6 was reduced insignificantly by the fentanyl solutions compared with adrenaline only. The quality of analgesia as assessed by the need for analgesic supplements was superior for the patients given fentanyl. An observer rating of pain and visual analogue pain scoring by the patient also indicated superior analgesia with fentanyl supplementation. Two patients experienced respiratory depression after extradural fentanyl and were given naloxone. Two neonates were also given naloxone. Close supervision is therefore recommended in the early postoperative period when this technique is used.

Adjuvants, Anesthesia↗

PubMed1998

Fentanyl augments the blockade of the sympathetic response to incision (MAC-BAR) produced by desflurane and isoflurane: desflurane and isoflurane MAC-BAR without and with fentanyl.

BACKGROUND: Heart rate (HR) or mean arterial blood pressure (MAP) may increase in response to incision despite the absence of a motor response. The authors hypothesized that the MAC-BAR (minimum alveolar concentration of an anesthetic that blocks adrenergic response to incision) for isoflurane would exceed that for desflurane, and that fentanyl would decrease the MAC-BAR for each anesthetic in a dose-dependent manner. METHODS: Seventy-one patients were randomly allocated to one of six groups: desflurane or isoflurane without fentanyl or with 1.5 or 3 microg/kg fentanyl given intravenously 5 min before surgical incision. Anesthesia was induced with 2 mg/kg propofol given intravenously, and tracheal intubation facilitated with 0.1 mg/kg given intravenously. The first patient in each group received 1 MAC (end-tidal) of the inhaled anesthetic in 60% nitrous oxide (0.55 MAC), balance oxygen, maintained for at least 10 min before incision. The response was considered positive if the HR or MAP increased 15% or more. If the response was positive, the end-tidal concentration given to the next patient was 0.3 MAC greater; if the response was negative, the end-tidal concentration was 0.3 MAC less. The MAC-BAR level was calculated as the mean of four independent cross-over responses in each group. RESULTS: Desflurane and isoflurane anesthesia with 60% nitrous oxide did not change HR (P > 0.05) and decreased MAP (P < 0.05) before incision. Plasma epinephrine and norepinephrine concentrations after anesthesia and before incision were normal in all groups. The MAC-BAR level, without fentanyl, did not differ (P > 0.05) between desflurane (1.30 +/- 0.34 MAC [mean +/- SD]) and isoflurane (1.30 +/- 0.18 MAC). Fentanyl given at 1.5 microg/kg intravenously equivalently (P > 0.05) reduced the MAC-BAR for desflurane (to 0.40 +/- 0.18 MAC; P < 0.05) and isoflurane (to 0.55 +/- 0.00 MAC; P < 0.05), but a further increase in fentanyl to 3 microg/kg caused no greater decrease in the MAC-BAR for desflurane (0.48 +/- 0.16 MAC) and isoflurane (0.40 +/- 0.30 MAC). CONCLUSIONS: Clinically attainable doses of desflurane and isoflurane, in 60% nitrous oxide (0.55 MAC), block the cardiovascular response to surgical incision at 1.3 MAC. Fentanyl given at 1.5 microg/kg decreases the MAC-BAR for each agent with no further decrease produced by 3 microg/kg fentanyl.

Adolescent↗

PubMedDate not supplied

Cardiovascular dynamics after large doses of fentanyl and fentanyl plus N2O in the dog.

The effects of large doses of fentanyl (0.05 to 2 mg/kg) and fentanyl plus N2O on cardiovascular dynamics were determined in 10 unpremedicated dogs breathing 100% O2. Using computer analysis of the central aortic pulsepressure curve, stroke volume (SV), cardiac output, heart rate (HR), peripheral vascular resistance (PVR), and systolic, diastolic, and mean arterial blood pressures (BP) were determined while fentanyl was being given at a rate of 0.3 to 0.44 mg/min. Fentanyl caused a dose-related decrease in HR, which was significant at 0.05 mg/kg. Cardiac output, PVR, and systolic, diastolic, and mean arterial BP were also decreased and SV increased. The latter changes became significant at 0.1 mg/kg for diastolic BP; 0.15 mg/kg for cardiac output and mean BP; 0.25 mg/kg for sv and systolic BP; and at 1.25 mg/kg for peripheral vascular resistance. Addition of N2O after fentanyl did not significantly change any parameter, although SV, cardiac output, and HR were usually increased and PVR decreased. These data demonstrate that, while large doses of fentanyl or fentanyl plus N2O do alter cardiovascular dynamics in dogs, the changes appear to be less profound than those produced by equianalgesic doses of morphine. Our findings suggest that large doses of fentanyl-O2 may be an attractive alternative to morphine-O2 anethesia in critically ill patients.

Anesthesia, Inhalation↗

PubMed2005

The effects of intravenous fentanyl and intravenous fentanyl combined with bupivacaine infiltration on the hemodynamic response to skull pin insertion.

This study was conducted to compare the effects of intravenous fentanyl and intravenous fentanyl combined with bupivacaine infiltration on the hemodynamic response to skull pin insertion. 120 ASA I-II patients scheduled for elective craniotomy were included. The fentanyl group (group F, n = 60) received fentanyl during induction and prior to skull pin insertion (2 and 1 microg . kg, respectively). The fentanyl-bupivacaine group (group FB, n = 60) received the same doses of fentanyl as well as scalp infiltration with 0.25% bupivacaine. The heart rate (HR) was not significantly different between the groups. HR, at 5 minutes after skull pin insertion in the group F and at 1 and 5 minutes after skull pin insertion in group FB, significantly decreased in comparison to the baseline values (P < 0.05). In both groups, HR at 1 and 5 minutes after skull pin insertion was significantly lower than HR just before skull pin insertion (P < 0.05). In group FB, the mean arterial pressure (MAP) at 1 and 5 minutes after skull pin insertion were significantly lower than that in group F (P < 0.05). In group F, MAP at 1 minute after skull pin insertion was higher than that of just before skull pin insertion (P < 0.05); however, MAP at 5 minutes after skull pin insertion was lower than that of just before skull pin insertion (P < 0.05). In group FB, MAP at 1 and 5 minutes after skull pin insertion was lower than that of just before skull pin insertion (P < 0.05). The hemodynamic response to skull pin insertion was effectively suppressed with both methods. Still, the addition of scalp infiltration to fentanyl did not provide any additional benefit. Administering an additional dose (1 microg . kg) of fentanyl just before skull pin insertion is recommended as a simple and effective option that requires no extra time.

Adolescent↗

PubMed2006

Development of an enzyme-linked immunosorbent assay for fentanyl and applications of fentanyl antibody-coated nanoparticles for sample preparation.

A sensitive enzyme-linked immunosorbent assay (ELISA) was developed for the detection of fentanyl in serum and urine. The ELISA used an indirect competitive method produced by coating the plate with thyroglobulin conjugated with fentanyl hapten. Antibodies against fentanyl-hemocyanin were detected by a goat-anti-rabbit antibody conjugated with alkaline phosphatase. Calibration standard curves ranged from 0.5ng/ml to 50mug/ml (IC(50)=10ng/ml), and the limits of detection were 0.5 and 1.0ng/ml for serum and urine, respectively. The intra- and inter-assay variations were less than 8% and 10%, respectively. The antibody produced against fentanyl completely cross-reacted with p-fluorofentanyl, thienylfentanyl and 3-methylthienylfentanyl, cross-reacted highly with carfentanil (85%), but was considered non-cross-reactive with alpha-methylfentanyl (5%), sufentanil (<1%), alfentanil (<1%) and lofentanil (<1%). Nano-sized iron oxide magnetic particles coated with the developed fentanyl antibody were capable of specific binding and releasing of fentanyl from urine samples. This enabled the drug to be effectively pre-concentrated and decreased the limit of detection by approximately one order of magnitude. The analytical background noise was significantly reduced to enable fentanyl detection at concentrations originally below chromatographic limit of detection. The change of platform for antibody binding with nanoparticles demonstrated a novel use of antibodies for sample preparation and should facilitate drug screening by traditional ELISA.

Adjuvants, Anesthesia↗

PubMed1987

Induction of anesthesia with fentanyl or fentanyl plus etomidate in high-risk patients.

Anesthetic doses of fentanyl (46 +/- 1.3 micrograms/kg) and oxygen (group I) were compared to a moderate dose of fentanyl (3 to 4.7 micrograms/kg; mean = 3.54 +/- 0.1 micrograms/kg) + etomidate (0.4 mg/kg) intravenously (IV) (group II) during the anesthetic induction-endotracheal intubation sequence to evaluate hemodynamic changes and the incidence of side effects in 23 New York Heart Association class III and IV patients. Chest wall rigidity only occurred in group I (27%), and pain on injection (8%) and myoclonus (25%) only in group II. Patients in group I experienced transient, small increases in central venous pressure (immediately after induction) and mean pulmonary artery pressure (after tracheal intubation). Patients in group II had small, transient decreases in heart rate, mean arterial blood pressure and cardiac index after induction which returned to baseline levels immediately after tracheal intubation. The data indicate that a modest dose of fentanyl with etomidate is similar to a large (anesthetic) dose of fentanyl in terms of avoiding cardiovascular depression and preventing hemodynamic stimulation during and following the induction-tracheal intubation sequence. Our findings also demonstrate that these doses of fentanyl before etomidate decrease but do not eliminate side effects of etomidate. The results suggest that a modest dose of fentanyl followed by etomidate may be an attractive alternative to high doses of fentanyl in patients with limited cardiovascular reserve, especially when prolonged postoperative respiratory depression secondary to high doses of an opioid is undesirable.

Adult↗

PubMed2004

Transdermal fentanyl in HSCT patients: an open trial using transdermal fentanyl for the treatment of oral mucositis pain.

Fentanyl is a synthetic opioid that can be delivered through a transdermal therapeutic system (TTS). The aim of this study was to assess the efficacy of fentanyl TTS in treating oral mucositis pain in 75 adult hematopoietic stem cell transplant (HSCT) patients. The analysis was based on 62 patients who developed mucositis. Pain control was assessed by the patients using a visual analogue scale (VAS) from day 0 to day +33 after HSCT. Fentanyl TTS was administered at the patient's request. In all, 20 patients did not require fentanyl (group A). The first 22 patients asking for the patch received fentanyl 25 microg/h (group B) and the subsequent 20 patients received 50 microg/h (group C). There were no significant differences in pain relief between groups B and C. The expected effect of a decrease in mean pain score (mean of the VAS scores of all of the patients in the same group each day) following the application of fentanyl TTS was not noted. We can conclude that fentanyl TTS at the doses used in this study may not adequately relieve oral mucositis pain.

Administration, Cutaneous↗

PubMed2005

Hemodynamic, hepatorenal, and postoperative effects of desflurane-fentanyl and midazolam-fentanyl anesthesia in coronary artery bypass surgery.

OBJECTIVE: The purpose of this study was to compare the hemodynamic, hepatorenal, and postoperative effects of desflurane-fentanyl and midazolam-fentanyl anesthesia during coronary artery bypass surgery. DESIGN: Prospective study. SETTING: University hospital. PARTICIPANTS: Sixty patients undergoing elective coronary artery bypass grafting surgery with ejection fraction more than 45%. INTERVENTIONS: Anesthesia was induced with etomidate, 0.2 mg/kg, and fentanyl, 5 microg/kg, in group D (n = 30) and with midazolam, 0.1 to 0.3 mg/kg, and fentanyl, 5 microg/kg, in group M (n = 30). Anesthesia was maintained with desflurane, 2% to 6%, and fentanyl, 15 to 25 microg/kg, in group D and midazolam infusion, 0.1 to 0.5 mg/kg/h, and fentanyl, 15 to 25 microg/kg, in group M. MEASUREMENTS AND MAIN RESULTS: Hemodynamic monitoring included a 5-lead electrocardiogram, a radial artery catheter, and a pulmonary artery catheter. Data were obtained before induction of anesthesia (t0), after induction of anesthesia (t1), after intubation (t2), after surgical incision (t3), after sternotomy (t4), before cardiopulmonary bypass (t5), after protamine infusion (t6), and at the end of the surgery (t7). Blood samples were obtained to measure total bilirubin, aspartate aminotransferase, gamma glutamyl transferase, lactate dehydrogenase, alkaline phosphatase, creatinine, and blood urea nitrogen just before induction of anesthesia and at the first, fourth, and 14th days postoperatively. CONCLUSIONS: Intraoperative hemodynamic responses were similar in both groups, and transient hepatic and renal dysfunctions were observed in the postoperative period in both groups. The extubation and intensive care unit discharge times were found to be shorter in the desflurane-fentanyl group.

Adult↗

PubMedDate not supplied

Epinephrine is not a useful addition to intrathecal fentanyl or fentanyl-bupivacaine for labor analgesia.

BACKGROUND AND OBJECTIVES: Intrathecal fentanyl provides effective labor analgesia for a limited time with frequent side effects. We evaluated the effects of adding epinephrine to intrathecal fentanyl with and without bupivacaine. METHODS: Eighty healthy, term, nulliparous parturients with cervical dilation of 5 cm or less received combined spinal-epidural (CSE) analgesia. Subjects were randomized in a double-blind fashion to 1 of 4 intrathecal solutions containing fentanyl 35 microg with either saline (F); bupivacaine 2.5 mg + saline (FB); bupivacaine 2.5 mg + epinephrine 100 microg (FBE); or epinephrine 100 microg + saline (FE). Patients were evaluated for visual analog pain score, duration of spinal analgesia (time until patient request for additional analgesia), nausea/vomiting, pruritus, sensory and motor block, maternal blood pressure, and fetal heart rate (FHR). RESULTS: Intrathecal bupivacaine significantly prolonged fentanyl analgesia with or without epinephrine (P =.018), but epinephrine did not significantly prolong the duration of fentanyl alone or with bupivacaine (F, 92 +/- 39 minutes; FB, 125 +/- 31 minutes; FBE, 134 +/- 42 minutes; and FE, 117 +/- 48 minutes). Intrathecal epinephrine was associated with a higher incidence of severe nausea (P =.001), and the FBE group had more lower extremity weakness (P =.047). There was no difference in the incidence of severe pruritus, FHR deceleration, or delivery outcome between the groups. CONCLUSIONS: These results suggest that intrathecal epinephrine does not prolong the duration of fentanyl or fentanyl with bupivacaine for labor analgesia in nulliparous parturients. Additionally, intrathecal epinephrine did not decrease the incidence of side effects and therefore cannot be recommended.

Adult↗