EPIDURAL AND INTRAVENOUS FENTANYL PRODUCE EQUIVALENT EFFECTS DURING MAJOR SURGERY

被引:25
作者
GUINARD, JP
CARPENTER, RL
CHASSOT, PG
机构
[1] CHU VAUDOIS,ANESTHESIOL SERV,LAUSANNE,SWITZERLAND
[2] VIRGINIA MASON MED CTR,DEPT ANESTHESIOL,SEATTLE,WA
关键词
ANALGESICS; EPIDURAL; FENTANYL; INTRAVENOUS; ANESTHETIC TECHNIQUES;
D O I
10.1097/00000542-199502000-00008
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
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 mu g 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 mu g, 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(1 and 846 +/- 257 mM), or urinary epinephrine (12 +/- 3.7 and 13.1 +/- 9.2, mu g/sample) and norepinephrine (42.7 +/- 26.7 and 39.1 +/- 27.6, mu g/sample). Conclusions: There appears to be no clinical advantage to epidural administration of fentanyl over intravenous administration during anesthesia for major surgery.
引用
收藏
页码:377 / 382
页数:6
相关论文
共 24 条
[11]   INTRATHECAL MORPHINE DOES NOT REDUCE MINIMUM ALVEOLAR CONCENTRATION OF HALOTHANE IN HUMANS - RESULTS OF A DOUBLE-BLIND-STUDY [J].
LICINA, MG ;
SCHUBERT, A ;
TOBIN, JE ;
NICODEMUS, HF ;
SPITZER, L .
ANESTHESIOLOGY, 1991, 74 (04) :660-663
[12]  
LOPER KA, 1990, ANESTH ANALG, V70, P72
[13]   PREVENTION AND TREATMENT OF HYPOTENSION DURING CENTRAL NEURAL BLOCK [J].
MCCRAE, AF ;
WILDSMITH, JAW .
BRITISH JOURNAL OF ANAESTHESIA, 1993, 70 (06) :672-680
[14]   ISOFLURANE MINIMUM ALVEOLAR CONCENTRATION REDUCTION BY FENTANYL [J].
MCEWAN, AI ;
SMITH, C ;
DYAR, O ;
GOODMAN, D ;
SMITH, LR ;
GLASS, PSA .
ANESTHESIOLOGY, 1993, 78 (05) :864-869
[15]   SENSITIVE RADIOIMMUNOASSAY FOR FENTANYL - PLASMA-LEVEL IN DOGS AND MAN [J].
MICHIELS, M ;
HENDRIKS, R ;
HEYKANTS, J .
EUROPEAN JOURNAL OF CLINICAL PHARMACOLOGY, 1977, 12 (02) :153-158
[16]   EPIDURAL DIAMORPHINE AND THE METABOLIC RESPONSE TO UPPER ABDOMINAL-SURGERY [J].
NORMANDALE, JP ;
SCHMULIAN, C ;
PATERSON, JL ;
BURRIN, J ;
MORGAN, M ;
HALL, GM .
ANAESTHESIA, 1985, 40 (08) :748-753
[17]  
Roberts F L, 1988, Anaesthesia, V43 Suppl, P14, DOI 10.1111/j.1365-2044.1988.tb09061.x
[18]   EPIDURAL SUFENTANIL FOR INTRAOPERATIVE AND POSTOPERATIVE ANALGESIA IN THORACIC-SURGERY - A COMPARATIVE-STUDY WITH INTRAVENOUS SUFENTANIL [J].
ROSSEEL, PMJ ;
VANDENBROEK, WGM ;
BOER, EC ;
PRAKASH, O .
ACTA ANAESTHESIOLOGICA SCANDINAVICA, 1988, 32 (03) :193-198
[19]   A RANDOMIZED DOUBLE-BLIND COMPARISON OF EPIDURAL VERSUS INTRAVENOUS FENTANYL INFUSION FOR ANALGESIA AFTER THORACOTOMY [J].
SALOMAKI, TE ;
LAITINEN, JO ;
NUUTINEN, LS .
ANESTHESIOLOGY, 1991, 75 (05) :790-795
[20]   A RANDOMIZED, DOUBLE-BLIND COMPARISON OF LUMBAR EPIDURAL AND INTRAVENOUS FENTANYL INFUSIONS FOR POSTTHORACOTOMY PAIN RELIEF - ANALGESIC, PHARMACOKINETIC, AND RESPIRATORY EFFECTS [J].
SANDLER, AN ;
STRINGER, D ;
PANOS, L ;
BADNER, N ;
FRIEDLANDER, M ;
KOREN, G ;
KATZ, J ;
KLEIN, J .
ANESTHESIOLOGY, 1992, 77 (04) :626-634