Patient-controlled analgesia and sedation with fentanyl in phacoemulsification under topical anesthesia

Purpose: To investigate the effects of intravenous (IV) patient-controlled sedation/analgesia with fentanyl during phacoemulsification surgery under topical anesthesia. Setting: Adnan Menderes University Medical School, Departments of Ophthalmology and Anesthesiology and Reanimation, Aydin, Turkey. Methods: In this double-blind randomized study, 68 patients were randomly allocated to 2 groups. In the fentanyl group comprising 34 patients, fentanyl was administered by patient-controlled analgesia (PCA) equipment in 5 mug bolus doses with a lockout period of 5 minutes after an IV loading dose of 0.7 mug/kg in 2 mL balanced salt solution. In the control group comprising 34 patients, a balanced salt solution was given without an analgesic drug by PCA equipment. Verbal pain scale (VPS) and sedation scores were recorded preoperatively and 5, 10, 15, 20, and 30 minutes after the start of surgery. Patient comfort and surgeon satisfaction were assessed postoperatively. Results: The sedation score was higher in the fentanyl group than in the control group at 5 and 10 minutes (P = .006 and P = .012, respectively). The VPS scores were higher in the control group than in the fentanyl group at 15 and 20 minutes (P = .02 and P = .016, respectively). Patients pressed the button for additional analgesia 2.6 times +/- 3.9 (SD) in the control group and 0.9 +/- 1.6 times in the fentanyl group (P = .025). Patient and surgeon satisfaction were higher in the fentanyl group than the control group (P = .023 and P = .018, respectively). Conclusion: The results of this study suggest that IV PCA with fentanyl has supplemental effects on analgesia and sedation during cataract surgery under topical anesthesia and increases patient comfort and surgeon satisfaction. (C) 2002 ASCRS and ESCRS.