Epidural and intravenous fentanyl produce equivalent effects during major surgery

Details

Serval ID
serval:BIB_2D817D2FF86E
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Epidural and intravenous fentanyl produce equivalent effects during major surgery
Journal
Anesthesiology
Author(s)
Guinard  J. P., Carpenter  R. L., Chassot  P. G.
ISSN
0003-3022 (Print)
Publication state
Published
Issued date
02/1995
Volume
82
Number
2
Pages
377-82
Notes
Clinical Trial
Journal Article
Randomized Controlled Trial --- Old month value: Feb
Abstract
BACKGROUND: The benefit of epidural versus intravenous fentanyl administration for postoperative analgesia is controversial. In the current study, the intraoperative effects of epidural versus intravenous fentanyl administration were compared during major surgery. METHODS: Twenty elective patients scheduled for thoracoabdominal esophagectomy under general anesthesia with propofol infusion were randomly allocated to receive either intravenous or epidural boluses of 50-100 micrograms fentanyl in a double-blind fashion to maintain hemodynamic stability. Plasma cortisol and fentanyl, as well as total urinary catecholamines, were obtained at the end of the operations. RESULTS: Hemodynamic variations were similar except that patients receiving epidural fentanyl had a lower incidence of heart rate reduction (> 20% reduction from baseline, P < 0.05). There were no differences in mean intraoperative fentanyl (1,115 +/- 430 and 1,010 +/- 377 micrograms, epidural and intravenous, respectively) or propofol (2,281 +/- 645 and 2,452 +/- 1,169 mg) doses, number of boluses of fentanyl (nine in both groups), plasma fentanyl concentration (1.13 +/- 0.4 and 1.02 +/- 0.46 ng/ml), or number of anesthesiologists correctly identifying the site of fentanyl administration. Similarly, there were no differences in plasma glucose (8.9 +/- 1.8 and 9.3 +/- 1.8 mM) and cortisol (696 +/- 446 and 846 +/- 257 mM), or urinary epinephrine (12 +/- 3.7 and 13.1 +/- 9.2, micrograms/sample) and norepinephrine (42.7 +/- 26.7 and 39.1 +/- 27.6, micrograms/sample). CONCLUSIONS: There appears to be no clinical advantage to epidural administration of fentanyl over intravenous administration during anesthesia for major surgery.
Keywords
Adult Aged Dose-Response Relationship, Drug Double-Blind Method Fentanyl/*administration & dosage Hemodynamic Processes Humans Infusions, Intravenous Injections, Epidural Metabolism/drug effects Middle Aged Prospective Studies
Pubmed
Web of science
Create date
28/01/2008 10:43
Last modification date
20/08/2019 13:12
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