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Epidural vs. intravenous fentanyl during colorectal surgery using a double-blind, double-dummy design
Background The overall therapeutic effectiveness of epidural fentanyl vs. the intravenous route is controversial. The present work describes a randomized, controlled, double‐blind, double‐dummy study of the intraoperative requirements of fentanyl administered by the intravenous or epidural routes du...
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| Published in: | Acta anaesthesiologica Scandinavica 2013-10, Vol.57 (9), p.1103-1110 |
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| Main Authors: | , , , , , , |
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| container_issue | 9 |
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| container_title | Acta anaesthesiologica Scandinavica |
| container_volume | 57 |
| creator | SADURNÍ, M. BELTRÁN DE HEREDIA, S. DÜRSTELER, C. PÉREZ-RAMOS, A. LANGOHR, K. ESCOLANO, F. PUIG, M. M. |
| description | Background
The overall therapeutic effectiveness of epidural fentanyl vs. the intravenous route is controversial. The present work describes a randomized, controlled, double‐blind, double‐dummy study of the intraoperative requirements of fentanyl administered by the intravenous or epidural routes during open colon surgery.
Methods
Thirty patients were randomized to receive intraoperative analgesia with boluses of fentanyl administered by either the epidural or intravenous route (2 μg/kg). The first fentanyl bolus was administered 10 min before incision, and repeated boluses were given when mean arterial pressure or heart rate increased more than 20% over basal values. General anaesthesia was maintained with a propofol infusion. Intraoperative fentanyl and propofol requirements, time to awakening, time to analgesia request, and incidence of adverse effects were recorded.
Results
Median [interquartile range (range)] fentanyl requirements in the epidural and intravenous groups were 0.81 [0.65 (0.47–2.61)] and 2.5 [1.08 (1.07–4.85)] μg/kg/h, respectively (P |
| doi_str_mv | 10.1111/aas.12118 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1432619172</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1432619172</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4168-80266d72a7380b5128e950842bf4928bca697915995198ac2e6d76bf46c04a3e3</originalsourceid><addsrcrecordid>eNp1kE1P3DAQhi3UChbooX-gitRLkcjij8Sxj9sVH5UiOEDF0XKS2ZWp42ztGMi_x7Ash0qdy2j0PvOO_SL0leA5SXWmdZgTSojYQzPCpMx5WfFPaIYxJnlJKnqADkN4SCMrpNxHB5SVHAtRzBCcb0wXvbbZY5hnxo1eP4IbYshW4EbtJpsl2bh11g528NCOCQ3Rr8FPWQyvgs66ITYW8sYa153upi72_ZR1EMzaHaPPK20DfHnvR-j3xfnd8iqvby5_LRd13haEi1xgynlXUV0xgZuSUAGyxKKgzaqQVDSt5rKSpJSyJFLolkKieRJ5iwvNgB2hH1vfjR_-Rgij6k1owVrtIP1JkYJRTmRKJKHf_0Efhuhdet0bhdNxWSXqZEu1fgjBw0ptvOm1nxTB6jV7lbJXb9kn9tu7Y2x66D7IXdgJONsCT8bC9H8ntVjc7izz7YYJIzx_bGj_R_GKVaW6v75UpBbXdf3zXi3ZC1Prm8A</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1432012897</pqid></control><display><type>article</type><title>Epidural vs. intravenous fentanyl during colorectal surgery using a double-blind, double-dummy design</title><source>Wiley-Blackwell Read & Publish Collection</source><creator>SADURNÍ, M. ; BELTRÁN DE HEREDIA, S. ; DÜRSTELER, C. ; PÉREZ-RAMOS, A. ; LANGOHR, K. ; ESCOLANO, F. ; PUIG, M. M.</creator><creatorcontrib>SADURNÍ, M. ; BELTRÁN DE HEREDIA, S. ; DÜRSTELER, C. ; PÉREZ-RAMOS, A. ; LANGOHR, K. ; ESCOLANO, F. ; PUIG, M. M.</creatorcontrib><description>Background
The overall therapeutic effectiveness of epidural fentanyl vs. the intravenous route is controversial. The present work describes a randomized, controlled, double‐blind, double‐dummy study of the intraoperative requirements of fentanyl administered by the intravenous or epidural routes during open colon surgery.
Methods
Thirty patients were randomized to receive intraoperative analgesia with boluses of fentanyl administered by either the epidural or intravenous route (2 μg/kg). The first fentanyl bolus was administered 10 min before incision, and repeated boluses were given when mean arterial pressure or heart rate increased more than 20% over basal values. General anaesthesia was maintained with a propofol infusion. Intraoperative fentanyl and propofol requirements, time to awakening, time to analgesia request, and incidence of adverse effects were recorded.
Results
Median [interquartile range (range)] fentanyl requirements in the epidural and intravenous groups were 0.81 [0.65 (0.47–2.61)] and 2.5 [1.08 (1.07–4.85)] μg/kg/h, respectively (P < 0.001). The epidural group had a shorter time to awakening, with a median of 8 min [4.5 (3–18)] compared with 20 min [12.5 (7–34)] for the intravenous group (P < 0.001). There were no significant differences in propofol requirements. The time to analgesia request was also delayed in the epidural group, with a median of 5 h [5.5 (1–16)] vs. 2 h [1 (1–5)] when fentanyl was administered intravenously (P < 0.001). The incidence of adverse effects was similar in both groups.
Conclusion
During major abdominal surgery, epidural administration requires lower doses of intraoperative fentanyl when compared with the intravenous route. Epidural fentanyl also facilitates early awakening and residual analgesia without increasing adverse events.</description><identifier>ISSN: 0001-5172</identifier><identifier>EISSN: 1399-6576</identifier><identifier>DOI: 10.1111/aas.12118</identifier><identifier>PMID: 23560884</identifier><identifier>CODEN: AANEAB</identifier><language>eng</language><publisher>England: Blackwell Publishing Ltd</publisher><subject>Aged ; Analgesia, Epidural - methods ; Analgesia, Patient-Controlled ; Analgesics, Opioid - administration & dosage ; Analgesics, Opioid - adverse effects ; Anesthesia, General ; Anesthesia, Intravenous - methods ; Anesthetics, Intravenous - administration & dosage ; Anesthetics, Intravenous - adverse effects ; Colon - surgery ; Colonic Neoplasms - surgery ; Double-Blind Method ; Female ; Fentanyl - administration & dosage ; Fentanyl - adverse effects ; Follow-Up Studies ; Humans ; Intraoperative Period ; Male ; Monitoring, Intraoperative ; Pain, Postoperative - drug therapy ; Propofol - administration & dosage ; Rectum - surgery ; Sample Size</subject><ispartof>Acta anaesthesiologica Scandinavica, 2013-10, Vol.57 (9), p.1103-1110</ispartof><rights>2013 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd</rights><rights>2013 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.</rights><rights>Copyright © 2013 The Acta Anaesthesiologica Scandinavica Foundation</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4168-80266d72a7380b5128e950842bf4928bca697915995198ac2e6d76bf46c04a3e3</citedby><cites>FETCH-LOGICAL-c4168-80266d72a7380b5128e950842bf4928bca697915995198ac2e6d76bf46c04a3e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23560884$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>SADURNÍ, M.</creatorcontrib><creatorcontrib>BELTRÁN DE HEREDIA, S.</creatorcontrib><creatorcontrib>DÜRSTELER, C.</creatorcontrib><creatorcontrib>PÉREZ-RAMOS, A.</creatorcontrib><creatorcontrib>LANGOHR, K.</creatorcontrib><creatorcontrib>ESCOLANO, F.</creatorcontrib><creatorcontrib>PUIG, M. M.</creatorcontrib><title>Epidural vs. intravenous fentanyl during colorectal surgery using a double-blind, double-dummy design</title><title>Acta anaesthesiologica Scandinavica</title><addtitle>Acta Anaesthesiol Scand</addtitle><description>Background
The overall therapeutic effectiveness of epidural fentanyl vs. the intravenous route is controversial. The present work describes a randomized, controlled, double‐blind, double‐dummy study of the intraoperative requirements of fentanyl administered by the intravenous or epidural routes during open colon surgery.
Methods
Thirty patients were randomized to receive intraoperative analgesia with boluses of fentanyl administered by either the epidural or intravenous route (2 μg/kg). The first fentanyl bolus was administered 10 min before incision, and repeated boluses were given when mean arterial pressure or heart rate increased more than 20% over basal values. General anaesthesia was maintained with a propofol infusion. Intraoperative fentanyl and propofol requirements, time to awakening, time to analgesia request, and incidence of adverse effects were recorded.
Results
Median [interquartile range (range)] fentanyl requirements in the epidural and intravenous groups were 0.81 [0.65 (0.47–2.61)] and 2.5 [1.08 (1.07–4.85)] μg/kg/h, respectively (P < 0.001). The epidural group had a shorter time to awakening, with a median of 8 min [4.5 (3–18)] compared with 20 min [12.5 (7–34)] for the intravenous group (P < 0.001). There were no significant differences in propofol requirements. The time to analgesia request was also delayed in the epidural group, with a median of 5 h [5.5 (1–16)] vs. 2 h [1 (1–5)] when fentanyl was administered intravenously (P < 0.001). The incidence of adverse effects was similar in both groups.
Conclusion
During major abdominal surgery, epidural administration requires lower doses of intraoperative fentanyl when compared with the intravenous route. Epidural fentanyl also facilitates early awakening and residual analgesia without increasing adverse events.</description><subject>Aged</subject><subject>Analgesia, Epidural - methods</subject><subject>Analgesia, Patient-Controlled</subject><subject>Analgesics, Opioid - administration & dosage</subject><subject>Analgesics, Opioid - adverse effects</subject><subject>Anesthesia, General</subject><subject>Anesthesia, Intravenous - methods</subject><subject>Anesthetics, Intravenous - administration & dosage</subject><subject>Anesthetics, Intravenous - adverse effects</subject><subject>Colon - surgery</subject><subject>Colonic Neoplasms - surgery</subject><subject>Double-Blind Method</subject><subject>Female</subject><subject>Fentanyl - administration & dosage</subject><subject>Fentanyl - adverse effects</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Intraoperative Period</subject><subject>Male</subject><subject>Monitoring, Intraoperative</subject><subject>Pain, Postoperative - drug therapy</subject><subject>Propofol - administration & dosage</subject><subject>Rectum - surgery</subject><subject>Sample Size</subject><issn>0001-5172</issn><issn>1399-6576</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><recordid>eNp1kE1P3DAQhi3UChbooX-gitRLkcjij8Sxj9sVH5UiOEDF0XKS2ZWp42ztGMi_x7Ash0qdy2j0PvOO_SL0leA5SXWmdZgTSojYQzPCpMx5WfFPaIYxJnlJKnqADkN4SCMrpNxHB5SVHAtRzBCcb0wXvbbZY5hnxo1eP4IbYshW4EbtJpsl2bh11g528NCOCQ3Rr8FPWQyvgs66ITYW8sYa153upi72_ZR1EMzaHaPPK20DfHnvR-j3xfnd8iqvby5_LRd13haEi1xgynlXUV0xgZuSUAGyxKKgzaqQVDSt5rKSpJSyJFLolkKieRJ5iwvNgB2hH1vfjR_-Rgij6k1owVrtIP1JkYJRTmRKJKHf_0Efhuhdet0bhdNxWSXqZEu1fgjBw0ptvOm1nxTB6jV7lbJXb9kn9tu7Y2x66D7IXdgJONsCT8bC9H8ntVjc7izz7YYJIzx_bGj_R_GKVaW6v75UpBbXdf3zXi3ZC1Prm8A</recordid><startdate>201310</startdate><enddate>201310</enddate><creator>SADURNÍ, M.</creator><creator>BELTRÁN DE HEREDIA, S.</creator><creator>DÜRSTELER, C.</creator><creator>PÉREZ-RAMOS, A.</creator><creator>LANGOHR, K.</creator><creator>ESCOLANO, F.</creator><creator>PUIG, M. M.</creator><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>H94</scope><scope>7X8</scope></search><sort><creationdate>201310</creationdate><title>Epidural vs. intravenous fentanyl during colorectal surgery using a double-blind, double-dummy design</title><author>SADURNÍ, M. ; BELTRÁN DE HEREDIA, S. ; DÜRSTELER, C. ; PÉREZ-RAMOS, A. ; LANGOHR, K. ; ESCOLANO, F. ; PUIG, M. M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4168-80266d72a7380b5128e950842bf4928bca697915995198ac2e6d76bf46c04a3e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Aged</topic><topic>Analgesia, Epidural - methods</topic><topic>Analgesia, Patient-Controlled</topic><topic>Analgesics, Opioid - administration & dosage</topic><topic>Analgesics, Opioid - adverse effects</topic><topic>Anesthesia, General</topic><topic>Anesthesia, Intravenous - methods</topic><topic>Anesthetics, Intravenous - administration & dosage</topic><topic>Anesthetics, Intravenous - adverse effects</topic><topic>Colon - surgery</topic><topic>Colonic Neoplasms - surgery</topic><topic>Double-Blind Method</topic><topic>Female</topic><topic>Fentanyl - administration & dosage</topic><topic>Fentanyl - adverse effects</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Intraoperative Period</topic><topic>Male</topic><topic>Monitoring, Intraoperative</topic><topic>Pain, Postoperative - drug therapy</topic><topic>Propofol - administration & dosage</topic><topic>Rectum - surgery</topic><topic>Sample Size</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>SADURNÍ, M.</creatorcontrib><creatorcontrib>BELTRÁN DE HEREDIA, S.</creatorcontrib><creatorcontrib>DÜRSTELER, C.</creatorcontrib><creatorcontrib>PÉREZ-RAMOS, A.</creatorcontrib><creatorcontrib>LANGOHR, K.</creatorcontrib><creatorcontrib>ESCOLANO, F.</creatorcontrib><creatorcontrib>PUIG, M. M.</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Acta anaesthesiologica Scandinavica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>SADURNÍ, M.</au><au>BELTRÁN DE HEREDIA, S.</au><au>DÜRSTELER, C.</au><au>PÉREZ-RAMOS, A.</au><au>LANGOHR, K.</au><au>ESCOLANO, F.</au><au>PUIG, M. M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Epidural vs. intravenous fentanyl during colorectal surgery using a double-blind, double-dummy design</atitle><jtitle>Acta anaesthesiologica Scandinavica</jtitle><addtitle>Acta Anaesthesiol Scand</addtitle><date>2013-10</date><risdate>2013</risdate><volume>57</volume><issue>9</issue><spage>1103</spage><epage>1110</epage><pages>1103-1110</pages><issn>0001-5172</issn><eissn>1399-6576</eissn><coden>AANEAB</coden><abstract>Background
The overall therapeutic effectiveness of epidural fentanyl vs. the intravenous route is controversial. The present work describes a randomized, controlled, double‐blind, double‐dummy study of the intraoperative requirements of fentanyl administered by the intravenous or epidural routes during open colon surgery.
Methods
Thirty patients were randomized to receive intraoperative analgesia with boluses of fentanyl administered by either the epidural or intravenous route (2 μg/kg). The first fentanyl bolus was administered 10 min before incision, and repeated boluses were given when mean arterial pressure or heart rate increased more than 20% over basal values. General anaesthesia was maintained with a propofol infusion. Intraoperative fentanyl and propofol requirements, time to awakening, time to analgesia request, and incidence of adverse effects were recorded.
Results
Median [interquartile range (range)] fentanyl requirements in the epidural and intravenous groups were 0.81 [0.65 (0.47–2.61)] and 2.5 [1.08 (1.07–4.85)] μg/kg/h, respectively (P < 0.001). The epidural group had a shorter time to awakening, with a median of 8 min [4.5 (3–18)] compared with 20 min [12.5 (7–34)] for the intravenous group (P < 0.001). There were no significant differences in propofol requirements. The time to analgesia request was also delayed in the epidural group, with a median of 5 h [5.5 (1–16)] vs. 2 h [1 (1–5)] when fentanyl was administered intravenously (P < 0.001). The incidence of adverse effects was similar in both groups.
Conclusion
During major abdominal surgery, epidural administration requires lower doses of intraoperative fentanyl when compared with the intravenous route. Epidural fentanyl also facilitates early awakening and residual analgesia without increasing adverse events.</abstract><cop>England</cop><pub>Blackwell Publishing Ltd</pub><pmid>23560884</pmid><doi>10.1111/aas.12118</doi><tpages>8</tpages></addata></record> |
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| ispartof | Acta anaesthesiologica Scandinavica, 2013-10, Vol.57 (9), p.1103-1110 |
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| subjects | Aged Analgesia, Epidural - methods Analgesia, Patient-Controlled Analgesics, Opioid - administration & dosage Analgesics, Opioid - adverse effects Anesthesia, General Anesthesia, Intravenous - methods Anesthetics, Intravenous - administration & dosage Anesthetics, Intravenous - adverse effects Colon - surgery Colonic Neoplasms - surgery Double-Blind Method Female Fentanyl - administration & dosage Fentanyl - adverse effects Follow-Up Studies Humans Intraoperative Period Male Monitoring, Intraoperative Pain, Postoperative - drug therapy Propofol - administration & dosage Rectum - surgery Sample Size |
| title | Epidural vs. intravenous fentanyl during colorectal surgery using a double-blind, double-dummy design |
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