Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Jun;71(3):213-219.
doi: 10.4097/kja.d.18.27097. Epub 2018 Apr 24.

The effects of adjuvant intrathecal fentanyl on postoperative pain and rebound pain for anorectal surgery under saddle anesthesia

Sung-Min Shim  1 , Jae-Ho Park  1 , Dong-Min Hyun  1 , Eui-Kyun Jeong  1 , Seong-Su Kim  1 , Hwa-Mi Lee  1
Affiliations

The effects of adjuvant intrathecal fentanyl on postoperative pain and rebound pain for anorectal surgery under saddle anesthesia

Sung-Min Shim et al. Korean J Anesthesiol. 2018 Jun.

Abstract

Background: Intrathecal opioid has been known to enhance the quality and prolong the duration of spinal anesthesia, as well as to reduce postoperative pain. The purpose of this study was to evaluate postoperative analgesic characteristics of intrathecal fentanyl for the first 48 hours after anorectal surgery under saddle anesthesia.

Methods: Eighty patients were recruited in our study. Forty patients were randomly allocated to group B that received 0.5% bupivacaine 5 mg with 0.3 ml normal saline. The other 40 patients were assigned to group BF which was given 0.5% bupivacaine 5 mg with fentanyl 15 μg. The primary outcome variable was a numeric rating scale (NRS) at six hours postoperatively. Secondary outcomes included changes in the NRS score between one and 48 hours postoperatively, consumption of rescue analgesics, and the frequency of rebound pain.

Results: Group BF exhibited a lower mean NRS score at postoperative six hours compared to group B (P < 0.001). However, the mean NRS score was not different after postoperative six hours between the two groups. The median consumption of rescue analgesics in group BF was less than that of group B (P = 0.028) and the frequency of rebound pain decreased in group BF when compared to group B (P = 0.021). The levels of sensory block were S1 dermatome and motor block scores were 0 for both groups. There was no significant difference in adverse effects between the groups.

Conclusions: Intrathecal fentanyl 15 μg for anorectal surgery under saddle anesthesia led to an improved pain score for the first six hours after surgery and decreased postoperative analgesic use. Rebound pain diminished with intrathecal fentanyl and adverse effects did not increase.

Keywords: Anorectal surgery; Bupivacaine; Intrathecal fentanyl; Saddle anesthesia.

PubMed Disclaimer

Figures

Fig. 1.
Fig. 1.
CONSORT flow diagram. SA: saddle anesthesia.
Fig. 2.
Fig. 2.
Numeric rating scale (NRS) pain score according to postoperative time. Group B without intrathecal fentanyl. Group BF with intrathecal fentanyl. Adjusted P value, 0.05/9 = 0.005. The asterisks (*) indicate statistically significant differences between the two groups (P < 0.001).
See this image and copyright information in PMC

References

    1. Famewo CE. Study of incidence of post-operative pain among Nigerian patients. Afr J Med Med Sci. 1985;14:175–9. - PubMed
    1. Sun MY, Canete JJ, Friel JC, McDade J, Singla S, Paterson CA, et al. Combination propofol/ketamine is a safe and efficient anesthetic approach to anorectal surgery. Dis Colon Rectum. 2006;49:1059–65. - PubMed
    1. Ye F, Feng YX, Lin JJ. A ropivacaine-lidocaine combination for caudal blockade in haemorrhoidectomy. J Int Med Res. 2007;35:307–13. - PubMed
    1. Li S, Coloma M, White PF, Watcha MF, Chiu JW, Li H, et al. Comparison of the costs and recovery profiles of three anesthetic techniques for ambulatory anorectal surgery. Anesthesiology. 2000;93:1225–30. - PubMed
    1. Read TE, Henry SE, Hovis RM, Fleshman JW, Birnbaum EH, Caushaj PF, et al. Prospective evaluation of anesthetic technique for anorectal surgery. Dis Colon Rectum. 2002;45:1553–8. - PubMed

LinkOut - more resources