Fentanyl: clinical use as postoperative analgesic--epidural/intrathecal route
- PMID: 1484196
- DOI: 10.1016/0885-3924(92)90022-a
Fentanyl: clinical use as postoperative analgesic--epidural/intrathecal route
Abstract
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.
Similar articles
-
Sufentanil: clinical use as postoperative analgesic--epidural/intrathecal route.J Pain Symptom Manage. 1992 Jul;7(5):271-86. doi: 10.1016/0885-3924(92)90061-l. J Pain Symptom Manage. 1992. PMID: 1352535 Review.
-
Comparison of ropivacaine with and without fentanyl vs bupivacaine with fentanyl for postoperative epidural analgesia in bilateral total knee replacement surgery.J Clin Anesth. 2017 Feb;37:7-13. doi: 10.1016/j.jclinane.2016.08.020. Epub 2016 Dec 22. J Clin Anesth. 2017. PMID: 28235533 Clinical Trial.
-
[Advantage of ropivacaine for postoperative epidural analgesia following leg orthopedic surgery].Masui. 2005 Jan;54(1):8-13. Masui. 2005. PMID: 15717460 Clinical Trial. Japanese.
-
Randomized, double-blind comparison of patient-controlled epidural infusion vs nurse-administered epidural infusion for postoperative analgesia in patients undergoing colonic resection.Br J Anaesth. 2007 Mar;98(3):380-4. doi: 10.1093/bja/ael367. Epub 2007 Feb 5. Br J Anaesth. 2007. PMID: 17283006 Clinical Trial.
-
A review of epidural and intrathecal opioids used in the management of postoperative pain.J Opioid Manag. 2012 May-Jun;8(3):177-92. doi: 10.5055/jom.2012.0114. J Opioid Manag. 2012. PMID: 22798178 Review.
Cited by
-
Efficacy of post-operative analgesia after posterior lumbar instrumented fusion for degenerative disc disease: a prospective randomized comparison of epidural catheter and intravenous administration of analgesics.Orthop Rev (Pavia). 2010 Mar 20;2(1):e9. doi: 10.4081/or.2010.e9. Orthop Rev (Pavia). 2010. PMID: 21808704 Free PMC article.
-
Effects of fentanyl added to a mixture of intrathecal bupivacaine and morphine for spinal anaesthesia in elective caesearean section.Rom J Anaesth Intensive Care. 2015 Oct;22(2):97-102. Rom J Anaesth Intensive Care. 2015. PMID: 28913464 Free PMC article.
-
Reinforcement of subarachnoid block by epidural volume effect in lower abdominal surgery: A comparison between fentanyl and tramadol for efficacy and block properties.Anesth Essays Res. 2012 Jul-Dec;6(2):189-94. doi: 10.4103/0259-1162.108310. Anesth Essays Res. 2012. PMID: 25885615 Free PMC article.
-
Epidural Oxycodone for Acute Pain.Pharmaceuticals (Basel). 2022 May 23;15(5):643. doi: 10.3390/ph15050643. Pharmaceuticals (Basel). 2022. PMID: 35631469 Free PMC article. Review.
-
An efficient, optimized synthesis of fentanyl and related analogs.PLoS One. 2014 Sep 18;9(9):e108250. doi: 10.1371/journal.pone.0108250. eCollection 2014. PLoS One. 2014. PMID: 25233364 Free PMC article.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources