Fentanyl Group Research Articles

A comparative study of clinical effects and recovery characteristics of intraoperative dexmedetomidine infusion with ketamine versus fentanyl as adjuvants in general anaesthesia.

Intraoperative dexmedetomidine infusion decreases the concurrent anaesthetic and analgesic requirement. However, because of slow onset and offset, it is often used with other drugs. Opioids have a depressant effect on the cardiorespiratory system while ketamine has the opposite pharmacodynamics. Hence, it was hypothesised that ketamine will have a better intraoperative haemodynamic profile compared to fentanyl. This study compared the clinical effects and recovery characteristics of ketamine versus fentanyl when used as an adjuvant along with dexmedetomidine infusion intraoperatively. A total of 80 patients (18-60 years) undergoing major surgeries were divided into two groups: Group (D + K) received an intraoperative infusion of ketamine 0.5 mg/kg/h, while group (D + F) received fentanyl 0.5 μg/kg/h along with intravenous dexmedetomidine 0.5 μg/kg/h. Intraoperative heart rate (HR), mean blood pressure, and oxygen saturation were recorded at 0 min, 10 min of induction, and thereafter every 30 min throughout the procedure. Ramsay sedation score (RSS) and visual analogue scale (VAS) score were measured at the end of the surgery, at 2 hours, 4 hours, and 6 hours. Reduction in HR and mean blood pressure was more with a tendency of developing hypotension in the fentanyl group compared to the ketamine group. Post-anaesthesia care unit (PACU) stay, need for muscle relaxant and VAS score for pain were also significantly lesser in the ketamine group. Dexmedetomidine with ketamine provided better haemodynamic stability and reduced PACU stay compared to dexmedetomidine with fentanyl.

Effect of dexmedetomidine versus fentanyl on recovery responses to tracheal extubation in vitrectomy, randomized, controlled trial

Background: Our study was to compare the effects of fentanyl 1 mcg/kg IV and dexmedetomidine 0.5 mcg/kg IV as single bolus doses on the IOP, quality of extubation, hemodynamic responses during extubation, postoperative sedation, postoperative pain, and complications. Methods: Sixty patients were recruited randomly into three groups. 5 min before extubation, Group (I): received IV 10 ml of normal saline. Group (II): received fentanyl 1 mcg/kg IV in 10 ml of normal saline. Group (III): received 0.5 mcg/kg dexmedetomidine IV in 10 ml of normal saline. Our primary outcome was the intraocular pressure; our secondary outcomes were hemodynamic, extubation quality, extubation and recovery duration, postoperative pain, postoperative sedation, and complications. Results: The dexmedetomidine group IOP upon extubation was shown to be more stable than the fentanyl group. The preoperative and at the end of the operation hemodynamics measured in the three groups did not show any appreciable changes. However, we found that patients receiving dexmedetomidine saw much smaller increases in HR, and MBP following medication administration compared to patients receiving fentanyl, and both groups also experienced significantly lower increases than the control group. Dexmedetomidine considerably improved extubation quality compared to fentanyl, and both groups were significantly better than the control group. The dexmedetomidine group had considerably shorter extubation times than the other two groups. Conclusion: In contrary to fentanyl 1 mcg/kg IV, dexmedetomidine 0.5 mcg/kg given IV 5 minutes before extubation stabilizes IOP, and hemodynamic responses to extubation, and promotes smooth extubation without extending recovery time or increasing postoperative complications.

Comparison of Nalbuphine Hydrochloride and Fentanyl Citrate for Total Intravenous Anaesthesia in Short Surgical Procedures: A Randomised Control Study

Introduction: Total Intravenous Anaesthesia (TIVA) with propofol is gaining acceptance for day care surgeries due to its advantages over inhalational agents. Opioids administered as premedication are known to enhance the hypnotic effect of propofol and provide intraoperative and postoperative analgesia. Aim: To compare the effectiveness of Nalbuphine and Fentanyl for postoperative analgesia in short surgical procedures. Materials and Methods: In present double-blinded randomised controlled trail conducted in the Department of Anaesthesia at the Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India, 60 patients aged 18 to 60 years, classified as American Soceity of Anaesthesiologists (ASA) Grade-I or II, and scheduled for elective short surgical procedures under TIVA were randomly assigned to two groups. Group N received Nalbuphine 0.05 mg/kg, and control Group F received 0.001 mg/ kg Fentanyl intravenously before induction. Parameters studied included pain scores, first rescue analgesia, haemodynamics, and side effects. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, USA, version 19.0 for Windows). Parametric data were analysed using paired and unpaired t-tests. Results: Data from a total of 60 patients (Group N mean age: 46.9±9.96 years and Group F mean age: 46.6±10.44 years) were collected and analysed. Both groups were comparable in terms of age, Body Mass Index (BMI), mean duration of surgery, and type of surgery (p > 0.05). Pain scores on the Visual Analogue Scale (VAS) were not significant upto 15 minutes after surgery, but thereafter, the VAS score was significantly lower in the Nalbuphine group (p-value < 0.05). Intraoperative episodes of significant hypotension were observed only in the Fentanyl group (p-value < 0.05). The total dose of propofol required was significantly lower in the Fentanyl group (p-value < 0.001). The time to the first rescue analgesia requirement (in minutes) was significantly shorter in the Fentanyl group (32.83±28.43) compared to the Nalbuphine group (56.37±25.31). Side effects such as postoperative sedation, nausea, and vomiting were observed in the Fentanyl group (p-value >0.05). Conclusion: Nalbuphine provided superior postoperative analgesic effects compared to Fentanyl when used as an analgesic component in TIVA. Postoperatively, pain scores were lower, and the time to the first rescue analgesia was longer in the Nalbuphine group.

A Comparative Study of Epidural Butorphanol and Epidural Fentanyl for Postoperative pain relief in Lower Limb Orthopaedic Surgeries.

Background: Epidural narcotic agonists like fentanyl, and morphine has been studied as an adjunct to Bupivacaine for intraoperative and to provide epidural postoperative analgesia. Side effects like pruritus, nausea, vomiting, respiratory depression, and urinary retention occur with their use. The search for an effective analgesic with no or low incidence of side effects is continuing. Aims and objective: To evaluate the onset of anaesthesia, duration of analgesia with epidural administration of Butorphanol and fentanyl in 2 groups. Observe and compare side effects between these groups during post-operative period. Material and Methods: We had done this study on 60 patients with Orthopaedic fractures (lowerlimb), which are treated with IM IL nailing femur and tibia distributed to two groups of 30 each. Surgery was done under CSE technique, with Group A receiving butorphanol and Group B Fentanyl as adjuvant. The onset, duration of analgesia and side effects were recorded in each group. Results: The onset of analgesia was rapid in Fentanyl group (3.26+/- 0.95) than Butorphanol group (6.54 +/-1.10). Duration of analgesia was longer in Butorphanol group (330 +/- 62 minutes) in comparison to Fentanyl group (210 +/- 32 minutes). Quality of analgesia is better in Butorphanol group (80%) than Fentanyl group (43 %). Side effects were more in Group B than Group A. Conclusion: Epidural Fentanyl has faster onset of analgesia. Epidural Butorphanol has longer duration of analgesia with better quality of analgesia. Epidural butorphanol has fewer side effects when compared to Fentanyl.

Comparison of the Effect of Intravenous Fentanyl with Low-Dose Ketamine on Pain Relief in Patients Taking Methadone and Suffering from Limb Fractures.

Given the significance of pain control in addicted patients and the prominence of not using opioids due to patient's drug dependence, the present study aimed at comparing and evaluating the effect of intravenous fentanyl with low-dose ketamine on pain relief in patients taking methadone and suffering from limb fractures. The present double-blind randomized clinical trial was performed on 100 patients taking methadone and suffering from limb fractures. The patients were divided into two groups receiving 1 μg/kg single dose of fentanyl and 0.3 mg/kg single dose of ketamine (low-dose ketamine). Patients' pain scores and the incidence rate of complications were recorded before the intervention, and 15, 30, and 60 min after drug administration and were then compared between the two groups. The mean pain score of patients 15 min after the intervention was significantly lower in the low-dose ketamine group with a mean of 2.50 ± 1.34 as compared with the fentanyl group with a mean of 7.10 ± 1.43 (P < 0.001). However, the mean pain score was not significantly different between the two groups 30 and 60 min after the intervention (P > 0.05). In addition, the incidence rate of complications was not significantly different between the two groups (P > 0.05). According to the results of this study, low-dose ketamine as compared with fentanyl relieves pain in the mentioned patients with a faster effect and in a shorter time although no difference can be found between the pain scores of the two groups 30 and 60 min after the intervention.

A randomized comparative study of preoperative fentanyl and dexmedetomidine nebulization on the hemodynamic response to endotracheal intubation

Background: Intense sympathetic activity is linked to laryngoscopy and endotracheal intubation, which could lead to intraoperative problems. We undertook this study to compare the effects of preoperative nebulized Fentanyl and Dexmedetomidine on hemodynamic response to laryngoscopy and endotracheal intubation, taking advantage of their high bioavailability and better absorption through nasal mucosa. Aim and Objectives: The objectives of the study were (i) to compare the effect of preoperative nebulization on the hemodynamic response to laryngoscopy and intubation; and (ii) to assess intraoperative requirement of anesthetic agents. Materials and Methods: This prospective, randomized, and comparative study was conducted among 100 American Society of Anesthesiologists (ASA) I, II patients (of either gender) undergoing elective surgeries and requiring tracheal intubation, were randomized in two groups. Group A was given Fentanyl Nebulization (2 μg/kg in 4 ml of 0.9% saline) and Group B was given Dexmedetomidine nebulization (1 μg/kg in 4 ml of 0.9% saline) 10 min before anesthesia induction. Hemodynamic parameters were noted before and immediately after induction, 1 min, 5 min and 10 min after intubation. The main goal was to assess how Fentanyl and dexmedetomidine nebulization affect the laryngoscopy and intubation-induced stress response. The secondary outcome was to assess the intraoperative requirement of anesthetic agents, observe adverse effects of study drug and sedation score. Results: Dexmedetomidine nebulization was found to be more effective in blunting rise in heart rate post laryngoscopy compared to Fentanyl Nebulization (P &lt; 0.0001) as well as in MAP after 10 min of intubation (P &lt; 0.0001). Requirement of propofol was seen to be significantly reduced in Group B compared to Group A (P &lt; 0.05). Sedation scores were significantly higher in Group B (P &lt; 0.05). No evidence of side effects was observed in any group. Conclusion: Nebulisation of dexmedetomidine was found to be more effective in attenuation of stress response of laryngoscopy and intubation compared to nebulisation of fentanyl, with stable intraoperative hemodynamic and no significant side effects.

Dexmedetomidine versus fentanyl for sedation in extremely preterm infants.

Few studies have compared the efficacy and complications of dexmedetomidine (DEX) and fentanyl (FEN) in extremely preterm infants. We conducted a single-institution, retrospective controlled before and after study of preterm infants before 28 weeks of gestation admitted between April 2010 and December 2018 to compare the complications and efficacy of DEX and FEN for preterm infants. Patients were administered FEN prior to 2015 and DEX after 2015 as the first-line sedative. A composite outcome of death during hospitalization and developmental quotient (DQ) < 70 at a corrected age of 3 years was compared as the primary outcome. Secondary outcomes including postmenstrual weeks at extubation, days of age when full enteral feeding was achieved and additional sedation by phenobarbital (PB) were compared. Sixty-six infants were enrolled into the study. The only perinatal factor that differed between the FEN (n = 33) and DEX (n = 33) groups was weeks of gestation. The composite outcome of death and DQ < 70 at a corrected age of 3 years were not significantly different. Postmenstrual weeks at extubation did not significantly differ between groups after adjustment for weeks of gestation and being small for gestational age. On the other hand, full feeding was significantly prolonged by DEX (p = 0.031). Additional sedation was less common in the DEX group (p = 0.044). The composite outcome of death and DQ < 70 at a corrected age of 3 years were not significantly different by DEX or FEN for primary sedation. Prospective randomized controlled trials should examine the long-term effects on development.

Comparative Study of Opioid Free versus Opioid Anaesthesia in Patients Undergoing Laparoscopic Cholecystectomy

Introduction: Opioids have been used as a part of balanced anaesthesia and have known side effects. Opioid Free Analgesia is an emerging technique, based on avoiding intraoperative opioids.&#x0D; Aims: To compare the effectiveness of opioid-free versus opioid based anaesthesia.&#x0D; Methods: This comparative study involved 100 patients undergoing elective laparoscopic cholecystectomy under general anaesthesia with American Society of Anaesthesiologists I or II physical status. Out of 100 patients, 50 received Fentanyl (Group A) while another 50 (Group B) received Ketamine and Lignocaine. Parameters measured and compared were the gender, age, weight, ASA physical status, hemodynamic stability, postoperative pain intensity (VAS) and opioid requirements, as well as side effects.&#x0D; Results: Both groups were comparable with regards to age, gender, weight, American Society of Anaesthesiologists I or II physical status, mean duration of surgery. There was no significant difference between groups hemodynamics at all assessed times (p&gt;0.05) intraoperatively. Visual Analogue Scale pain score in the first 24 hours postoperatively showed that patients in Group A, at all analyzed time points had higher Visual Analogue Scale scores than Group B, but statistically significant difference was confirmed during the first hour (p = 0.001). Seven(14%) in Group A and 5(10%) patients in Group B got intravenous tramadol only once while 5(10%) patients in Group A required twice, which was statistically significant (p=0.05). Intraoperatively, 2 patients (4%) in group A had bradycardia while none in group B, which was statistically insignificant (p=0.153). Postoperatively, nausea was more in group A than Group B i.e. 8% vs 4% (p=0.4).&#x0D; Conclusion: Opioid Free anaesthesia has a better benefit over Opioid anaesthesia with regard to postoperative pain score, opioid consumption and its side effects.

Influence of Constant Rate Infusions of Fentanyl Alone or in Combination With Lidocaine and Ketamine on the Response to Surgery and Postoperative Pain in Isoflurane Anesthetized Dogs Undergoing Unilateral Mastectomy: A Randomized Clinical Trial

The aim of this study was to compare the effects of constant rate infusions (CRI) of fentanyl alone or combined with lidocaine and ketamine (FLK), on physiological parameters, isoflurane requirements and the number of postoperative analgesic rescues in dogs undergoing unilateral mastectomy. Twenty-two dogs were premedicated with acepromazine 0.02 mg/kg and morphine 0.5 mg/kg and anesthetized with propofol and isoflurane. Dogs were randomly assigned to 1 of 2 groups: Fentanyl group (fentanyl 5 µg/kg loading dose [LD] and 9 µg/kg/h CRI; n = 11); FLK group (fentanyl [same doses]; lidocaine 2 mg/kg LD and 3 mg/kg/h CRI; ketamine 1.0 mg/kg LD and 0.6 mg/kg/h CRI; = 11). Intraoperative evaluations were performed before the start of surgery and administration of the treatments (T0); three minutes after the LD (T1); during incision and tissue divulsion (T2); during closure of the surgical wound (T3). Meloxicam (0.1 mg/kg) was administered at T3. Blood samples were collected for determination of plasma concentrations of fentanyl, lidocaine and ketamine. Pain scores and the number of postoperative analgesic rescues with morphine (0.5 mg/kg) were evaluated for 24 hours postoperatively using the short form of the Glasgow Composite Measure Pain Scale. Compared to T0, significant decreases in heart rate (from 84 ± 28 to 53 ± 16 bpm in the Fentanyl group and from 93 ± 16 to 63 ± 15 bpm in FLK) and mean arterial pressure (from 61 ± 5 to 49 ± 10 mmHg in Fentanyl and from 59 ± 3 to 38 ± 6 mmHg in FLK) were observed at T1. Arterial hypotension was transient, with normalization of values at T2 and T3. The expired fraction of isoflurane did not differ significantly between the groups. Plasma concentrations of fentanyl, lidocaine and ketamine remained within the therapeutic range. Postoperatively, the number of dogs requiring analgesic rescue was significantly lower in the FLK (0/11, 0%) than in the Fentanyl group (5/11, 45%). In dogs administered morphine and meloxicam as part of the anesthesia protocol, an intraoperative CRI of FLK abolished the requirement for postoperative analgesic rescue for 24 hours in dogs undergoing mastectomy.

A COMPARATIVE STUDY OF THE EFFECTS OF INTRATHECAL MIDAZOLAM(1MG) AND FENTANYL(25 MICROGRAMS) AS ADDITIVES TO INTRATHECAL HYPERBARIC BUPIVACAINE 0.5%(15MG) IN SPINALANAESTHESIA

Background: Various intrathecal additives are added to local anesthetics to increase the speed of onset, improve the quality, and prolong the inuence of spinal anesthesia. Midazolam has a synergistic effect on postoperative analgesia when administered intrathecally with bupivacaine. Opioids such as fentanyl are extensively used as an adjunct to local anesthetics in neuraxial blockade to enhance the duration of postoperative analgesia. Aim: The aim of our study was to compare the effects of intrathecal midazolam(1mg) and fentanyl (25 micrograms) as additives to intrathecal hyperbaric bupivacaine 0.5% (15mg) with spinal anesthesia.Materials and Methods: Prospective, observational study was conducted at SRI SIDDHARTHAMEDICAL COLLEGE AND RESEARCH INSTITUTE,TUMKUR. from 1st Jan 2021 to 30th June 2022 on 94 patients. Results: In Bupivacaine and Midazolam group, mean duration of surgery was 84 ± 12.3 minutes and in Bupivacaine and Fentanyl group, mean duration of surgery was 92 ± 14.4 minutes. In Bupivacaine and Midazolam group, mean time for onset of sensory block was 7.1 ± 0.9 minutes and in Bupivacaine and Fentanyl group, mean time for onset of sensory block was 6.9 ± 1.1 minutes. In Bupivacaine and Midazolam group, mean time for onset of motor block was 7.6 ± 1.3 minutes and in Bupivacaine and Fentanyl group, mean time for onset of motor block was 8.1± 1.2 minutes. In Bupivacaine and Midazolam group, mean duration of sensory block was 213.6 ± 16.1 minutes and in Bupivacaine and Fentanyl group, mean duration of sensory block was 218.3 ± 19.2 minutes. Conclusion- The onset of sensory and motor blockade was comparable in Fentanyl with Bupivacaine and Midazolam with Bupivacaine. Additional of intrathecal Fentanyl prolonged the duration of analgesia signicantly than that of Midazolam. There was signicantly less consumption of rescue of analgesia among patients with Fentanyl with Bupivacaine than Midazolam with Bupivacaine. The duration of postoperative analgesia was also signicantly prolonged in the fentanyl and midazolam groups

P038Ketamine versus fentanyl for surgical abortions: A randomized noninferiority trial

<h3>Objectives</h3> To compare patient satisfaction with anesthesia after first-trimester surgical abortions among patients receiving intravenous ketamine vs. IV fentanyl for procedural sedation. <h3>Methods</h3> This was a randomized noninferiority trial comparing IV ketamine to IV fentanyl for surgical abortions up to 13 6/7 weeks' gestation. Patients were randomized to receive midazolam 2 mg IV and either ketamine 200–500 mcg/kg IV over two minutes, repeated every five minutes until appropriate analgesia was achieved, or fentanyl 0.5–1 mcg/kg IV over two minutes, repeated every five minutes until appropriate analgesia was achieved. The primary outcome, patient satisfaction, was measured using the Iowa Satisfaction with Anesthesia Scale (ISAS) immediately post-procedure. Secondary outcomes included postoperative pain and additional pain medication given. We calculated a sample size of 84 with a noninferiority margin of 0.6 on the ISAS scale with 80% power, one-sided type 1 error of 0.025, and further increased this number to 110 to account for potential dropout. <h3>Results</h3> From April to October 2021, 184 patients were screened and 110 were randomized (57 to ketamine and 53 to fentanyl). Demographics were similar between groups. The primary outcome, patient satisfaction with anesthesia, was noninferior in the ketamine group (mean score, 2.4; SD, 0.8) compared with the fentanyl group (mean score, 2.2; SD, 0.9) with a risk difference of 0.20 (95% CI, 0.11–0.52). Secondary outcomes were similar between the groups. <h3>Conclusions</h3> Compared with IV fentanyl, IV ketamine is noninferior for patient satisfaction with anesthesia when used for procedural sedation for first-trimester surgical abortions.

Postoperative Nausea and Vomiting in Opioid-Free Anesthesia Versus Opioid Based Anesthesia in Laparoscopic Cholecystectomy.

Background: Postoperative nausea and vomiting (PONV) is a usual complication in patients undergoing laparoscopic cholecystectomy. Minimized opioid use due to surgery has been shown to have a better effect on patient recovery after surgery. In this study we evaluate the effect of opioid free anesthesia for postoperative nausea and vomiting in laparoscopic cholecystectomy. Materials and methods: 80 patients aged 20-65 years old were included in this randomized, clinical and prospective trial. The patients belonged to the ASA classifications 1 and 2 and were scheduled for laparoscopic cholecystectomy. Patients were classified into two groups: group 1 (fentanyl group- FG), which included 40 patients who received opioid anesthesia, and group 2 (opioid free anesthesia group-OFAG) which included 40 patients who received opioid free anesthesia. In patients from group 1 (fentanyl group -FG) introduction to general anesthesia consisted of giving midazolam at 0.04 mg/kg, fentanyl at 0.002 mg/kg, 2 mg/kg of propofol and 0.6 mg/kg of rocuronium bromide. These patients received fractionated bolus doses of fentanyl during surgery. Prior to general anesthesia these patients did not receive dexamethasone. The patients from group 2 (opioid free anesthesia group - OFAG) received dexamethasone at 0.1 mg/kg and 1 g of paracetamol before introduction to anesthesia as a pre-emptive analgesia. Introduction to anesthesia consisted of giving midazolam at 0.04 mg/kg, lidocaine at 1 mg/kg, propofol at 2 mg/kg, ketamine at 0.5 mg/kg, and 0.6 mg/kg of rocuronium bromide. Immediately after intubation, continuous intravenous infusion with lidocaine at 2 mg/kg/h and magnesium sulfate at 1.5 g/h was given. In this group, fentanyl was not given either during the introduction of anesthesia or during the intraoperative period. Immediately after extraction of the gallbladder patients from group 2 (OFAG) received 2.5 g of metamizole intravenously. PONV were recorded in the postoperative period of 24 hours after surgery. Results: There was no significant difference with respect to age, weight, sex, duration of surgery, and anesthesia time. PONV at different time intervals were statistically not significant at all postoperative time points - 1 hr, 4 hr, 8 hr, 12 hr and 24 hr after surgery in fentanyl group compared to opioid free anesthesia group. Even not statistically significant, PONV have occurred more often in patients who received opioid anesthesia. Conclusion: Postoperative nausea and vomiting occurs more often in patients who received opioids during laparoscopic cholecystectomy compared to patients who received opioid free anesthesia, but without statistical significance.

Comparison of Continuous Infusion of Intravenous Tramadol and Fentanyl on Postoperative Analgesia in Cardiac Surgery

Objective: To compare the efficacy between the fentanyl and tramadol infusion on post-operative cure of pain after a valvular heart surgery. Methods: Total of 40 patients were included in the study who underwent valvular heart surgery. Patients were divided into two groups, 20 patients were included in Tramadol group while 20 patients were assigned the Fentanyl group. After getting off from cardiopulmonary bypass pump (CPB), drug infusions were started. The drugs were continued for a duration of 48 hours after the surgery. The dose of Fentanyl was 0.5-1ug.kg-1.h-1 through continuous infusion for about 48 hours whereas Tramadol was given at a dose of 0.1-0.2 mg.kg- 1.h-1. Additionally, both the groups were also given intravenous paracetamol 1gm every 8 hours. Verbal rating scale comprising of 11 points was used to assess the efficacy of analgesia. The interval of data collection was 6h, 12h, 24h, 36h and 48h after surgery. Results: The mean cross clamping time, CPB time, mechanical ventilation, ICU stay and hospital stay of group F was 90.51±5.18 minutes, 120.65±5.58 minutes, 589.45±3.64 minutes, 4.01±0.45 days and 8.11±1.97 days, respectively. While, the mean cross clamping time, CPB time, mechanical ventilation time, ICU day and hospital days of group T was 86.91±4.11 minutes, 111.31±2.84 minutes, 507.45±5.54 minutes, 3.15±0.67 days and 7.4±1.14 days, respectively. The differences were statistically significant except hospital days (p=0.1777). Conclusion: It is evident from the given study that tramadol infusion is having equally analgesic characteristics as compared to fentanyl infusion after valvular heart surgery. Keywords: Cardiopulmonary bypass (CPB), Postoperative analgesia, Pain relief, assessment, Tramadol infusion.

Comparing Fentanyl Dosages of 1 Microgram per Kilogram of Body Weight and of 1.5 Micrograms per Kilogram of Body Weight in Relation to Cough Suppression during Bronchoscopy Procedures

BACKGROUND: Anaesthesia at bronchoscopy is a unique challenge for the anaesthesiologist as both the anaesthesiologist and operator work in the same airway. It is essential that administration of sedative agents must achieve the desired depth of sedation without risking airway patency, ventilation function and cardiovascular function. About 25% of bronchoscopy patients cite cough as the most unpleasant effect of this procedure. Fentanyl is widely chosen for a sedative agent because of their analgesic, sedative, and antitussive effects, however there has been no data regarding the optimal dose of fentanyl to suppress cough in bronchoscopy procedures. METHODS: We designed a research with 18 subjects received fentanyl in a dose of 1 μg / kgBW, 18 subjects received fentanyl in a dose of 1.5 μg / kgBW and 18 subjects received propofol in a dose of 2 mg / kgBW as a control group. We observed the depth of sedation using the Ramsay sedation score and duration of cough suppression in their bronchoscopy procedures. We also observed the alteration of blood pressure, pulse rate, respiratory rate and oxygen saturation. RESULTS: There was a significant difference in the depth of patient sedation between the control group and the treatment groups; as patients without fentanyl treatment were sedated deeper on the Ramsay 4 scale, patients in the treatment groups with either fentanyl of 1 µg / kgBW or 1.5 µg / kgBW had the depth of sedation on the Ramsay 2 scale and unable to reach moderate sedation as expected. Subjects with fentanyl treatments showed significantly better suppression effects against coughing compared to control group patients. As there also was a significance difference in suppression effects for coughing between the group receiving fentanyl treatment of 1 µg / kgBW and the group receiving fentanyl treatment of 1.5 µg / kgBW, we noticed a fentanyl treatment of 1 µg / kgBW was adequate to suppress cough although a dose of 1.5 µg / kgBW would show better cough suppression effect. Subjects in control group with 2 mg / kgBW of propofol experienced a more significant alteration in vital signs than the fentanyl group, either with a dose of 1 µg / kgBW or 1.5 µg / kgBW. Comparing and statistically analysing the two treatment groups of different dose of fentanyl, we found no significant difference in vital signs alteration between the two groups. DISCUSSION: Our study revealed that as fentanyl significantly suppressed cough reflex and larger dose would provide longer period of suppression. Subjects with fentanyl treatment showed more favourable altercation in systolic and diastolic blood pressure, pulse rate, respiratory rate and oxygen saturation compared to subjects in control group with 2 mg / kgBW of propofol, but comparing and statistically analysing the two groups of different dose of fentanyl, we found no significant difference in vital signs alteration

Comparison of fentanyl and nalbuphine as adjuvants to intrathecal 0.5% bupivacaine in lower limb surgeries: A randomised double-blind prospective study.

Local anaesthetics used in spinal anaesthesia have a limited duration of action. To prolong postoperative analgesia, adjuvants, mainly opioids, are used. As µ agonist drugs have side effects, other receptor agonists are considered. Nalbuphine is a safe and effective kappa agonist adjuvant. To compare the analgesic efficacy between fentanyl and nalbuphine adjuvants added to 3 mL of 0.5% intrathecal hyperbaric bupivacaine. This prospective, double-blind, comparative study was conducted in 60 patients of either sex belonging to the American Society of Anesthesiologists classes I and II aged 18-65 years undergoing lower limb surgery with entropy monitoring, randomly allocated into two groups. Group F (n = 30) received 0.5% hyperbaric bupivacaine (3 mL) + 25 µg (0.5 mL) fentanyl. Group N (n = 30) received 0.5% hyperbaric bupivacaine (3 ml) + 0.8 mg (0.5 mL) nalbuphine intrathecally. Hemodynamics, entropy, motor and sensory block characteristics, and complications were noted. The nalbuphine group had a significantly longer two-segment regression time of sensory blockade and extended analgesia duration than the fentanyl group. Haemodynamics, entropy, time for onset of sensory and motor blockade and adverse effects were comparable in both groups. Nalbuphine prolongs sensory blockade and postoperative analgesia duration with minimal side effects and is a safe intrathecal adjuvant.

Comparison of epidural dexmedetomidine to fentanyl in reducing ropivacaine dose in Programmed Intermittent Epidural Bolus plus Patient Controlled Epidural Analgesia during labor: A randomized, double-blind, controlled study.

Dexmedetomidine has been documented to reduce the dose of both intrathecal local anesthetic during cesarean delivery, and the concentration of ropivacaine needed for inducing analgesia during labor. However, few studies have compared adjuvant dexmedetomidine to fentanyl on how they impact the dose of ropivacaine required during labor. The aim of the current study was to evaluate the efficacy of epidural dexmedetomidine at doses of 0.3, 0.4, or 0.5 and 2 μg/ml of fentanyl (the traditional clinical concentration), when added to epidural 0.125% ropivacaine. This was a randomized, double-blinded study that comprised one hundred eighty-eight patients, allocated into four groups receiving either epidural fentanyl at 2 μg/ml, or dexmedetomidine at 0.3, 0.4, or 0.5 μg/ml for labor analgesia. The primary outcome was the amount of ropivacaine necessary per hour. Secondary outcomes included visual analogue pain scale (VAS), motor block (Bromage Scale), side effects, patient satisfaction, and neonatal outcomes. At the completion of the study, data from 165 participants were analyzed. The mean hourly amount of epidural ropivacaine administered was 16.2 ± 3.3, 14.0 ± 3.1, 13.1 ± 3.7 and 12.1 ± 2.5 ml/h in the 2 μg/ml fentanyl group, and the 0.3, 0.4 and 0.5 μg/ml dexmedetomidine groups, respectively. There was a significant difference among groups in the mean hourly consumption of epidural ropivacaine (P < 0.0001 for 1 way ANOVA). The frequency of PCEA (patient-controlled epidural analgesia) was significantly higher in the fentanyl group than in the three dexmedetomidine groups (P < 0.001), and similar among the dexmedetomidine groups. The mean values of the VAS among all groups were similar over time, P > 0.05. The incidence of pruritus in the fentanyl group was 17.5%, whereas no patient experienced pruritus in any of the dexmedetomidine groups, P < 0.0001. The study demonstrated that epidural dexmedetomidine (0.3 and 0.4 μg/ml) was superior to standard dose epidural fentanyl in reducing the mean hourly amount of ropivacaine administered, and minimizing opioid-related side effects. Further large and multicenter studies would be necessary to confirm the benefits of dexmedetomidine, and potentially serve as an alternative to opioids for routine use in labor analgesia. [http://www.chictr.org.cn/showproj.aspx?proj=62846], identifier [ChiCTR2000039067].

Peribulbar block for retinal surgery comparison among dexmedetomidine, fentanyl, and local anesthesia

Introduction Among all the regional blocks, the peribulbar block is one of the most popular for most ophthalmic procedures as it has few complications. Aim To study the effects of mixing local anesthetic with either dexmedetomidine or fentanyl in the peribulbar block for vitreoretinal surgery. Patients and methods The study included 40 adult patients (ASA II–IV) who had a peribulbar block for elective retinal surgery at Sohag University Hospital. All patients received the following combination: lidocaine 2%, bupivacaine 0.5%, hyaluronidase 15 IU/Ml, in addition to either 20 μg of fentanyl (group F) or 20 μg of dexmedetomidine (group D). The duration of postoperative analgesia, the onset, and duration of sensory and motor blocks, along with other complications, were recorded. Results The onset time of motor and sensory blocks was significantly longer in group F. For the duration of sensory and motor blocks, group D had a significantly greater duration than group F (P=0.05). Group D took substantially longer to request analgesia than group F (P=0.0002). Total paracetamol consumption was substantially higher in group F than in group D (P=0.001). The overall number of patients who required nalbuphine was substantially higher in group F (P=0.003) than in group D. At 2, 4, and 6 h postoperatively, the visual analog scale was statistically significantly greater in group F than in group D. Conclusion Dexmedetomidine-local anesthetic mixture in the peribulbar block for retinal surgery was superior to fentanyl-local anesthetic mixture regarding onset and duration of motor, sensory block, postoperative analgesia, and analgesic requirement.

Comparison of Attenuation of Hemodynamic Response to Laryngoscopy with Nalbuphine versus Fentanyl in Patients undergoing Laparoscopic Cholecystectomy

Aim: To compare the hemodynamic response in laryngoscopy with fentanyl versus nalbuphine in patients undergoing laparoscopic cholecystectomy. Study Design: Randomized controlled trial. Place and Duration of Study: Department of Anesthesiology, Surgical Intensive Care and Pain management, Dow University of Health and Science, Dr. Ruth K.M. PFAU, Civil Hospital Karachi from 17th July 2020 to 16th January 2021. Methodology: Sixty patients between the age of 20-60 years of both genders falling under ASA Class-I and II undergoing laparoscopic cholecystectomy for cholelithiasis which were randomly allocated into two treatment groups. Patients in Group A received fentanyl while Group B was given nalbuphine before endotracheal intubation. Outcome variables were mean heart rate and mean diastolic and systolic blood pressure measured 15 minutes after intubation. Results: The mean age was 41.7±11.9 years. There were 21 (35.0%) male and 39 (65.0%) female patients. Mean body mass index was 25.5±2.6 kg/m2. Thirty five (58.3%) patients belonged to ASA Class-I while 25 (41.7%) patients belonged to ASA class-II. There was no statistically significant difference between fentanyl and nalbuphine in terms of mean heart rate 15 minutes after intubation (87.37±3.30vs. 86.33±4.23 bpm; p-value=0.296). However, the mean diastolic (73.23±3.77 vs 81.40±4.79 mmHg; p&lt;0.001) and systolic (117.30±4.21 vs 121.53±4.75 mmHg) hypotension was observed in fentanyl group as compared to nalbuphine group. Conclusion: Intravenous fentanyl infusion significantly attenuated the hemodynamic response to tracheal intubation in terms of significantly lower mean diastolic and systolic blood pressure as compared to conventional practice of nalbuphine which is desirable in patients undergoing general anesthesia. Keywords: Endotracheal intubation, Hemodynamic response, Fentanyl, Nalbuphine

Shivering and changes in body temperature in patients undergoing caesarean section under spinal anaesthesia with bupivacaine vs bupivacaine and fentanyl: A randomized clinical study.

Shivering is common after spinal anesthesia in patients undergoing cesarean section. Various drugs have been used for its prevention. The primary aim of this study was to assess the efficacy of adding a small dose of fentanyl intrathecally (12.5 μg) in reducing the occurrence of intraoperative shivering and hypothermia and note any significant side effects in this subset of patients. In this randomized controlled trial, 148 patients undergoing cesarean section under spinal anesthesia were included. In 74 patients, spinal anesthesia was administered with 1.8 mL of hyperbaric bupivacaine (0.5%), and the remaining 74 patients received 12.5 μg of intrathecal fentanyl with 1.8 mL of hyperbaric bupivacaine. Both were compared to find the incidence of shivering and change in nasopharyngeal and peripheral temperature along with the temperature at the onset of shivering and the grade of shivering. The incidence of shivering was 9.46% in the intrathecal bupivacaine plus fentanyl group, which was significantly less than the group with intrathecal bupivacaine alone (41.89%). The nasopharyngeal and peripheral temperature showed a decreasing trend in both groups but were greater in the plain bupivacaine group. The addition of 12.5 μg of intrathecal fentanyl to bupivacaine in parturient undergoing cesarean section under spinal anesthesia significantly reduces the occurrence and intensity of shivering without its adverse effects such as nausea, vomiting, and pruritus, etc.

Fentanyl Versus Dexmedetomidine for the Prevention of Emergence Agitation in Children After Sevoflurane Anaesthesia: A Comparative Clinical Study.

IntroductionSevoflurane is widely used in pediatric anesthesia due to its rapid onset and offset of action, smooth induction, and less hepatotoxicity. However, it is associated with emergence agitation, which can be frightening and harm the patient or the caregiver. While a definite preventive measure of emergence agitation is in search, the use of some drugs is associated with a lesser incidence of emergence related to sevoflurane. Aims and objectiveThis study aimed to compare the efficacy of fentanyl with dexmedetomidine in preventing emergence agitation in children undergoing surgery with sevoflurane anesthesia. Also, we assessed the perioperative hemodynamic and postoperative recovery characteristics and side effects, if any, between children receiving the two groups of drugs.Material and methodWe conducted a prospective, double-blinded, randomized controlled trial after getting approval from the institutional ethical committee. A total of 120 patients were recruited into the study and divided into two groups, F and D, of 60 patients each. Patients in group F received an infusion of injection fentanyl at 1 mcg/kg and patients in group D received infusions of injection dexmedetomidine at 0.15 mcg/kg, respectively, after induction of general anaesthesia. Additionally, all patients received a caudal epidural block with 0.125% isobaric levobupivacaine. After the conclusion of surgery, we transferred the patients to the post-anaesthesia care unit for further observation and assessment.ResultThe Pediatric Anesthesia Emergence Delirium (PAED) score for emergence agitation was significantly greater in the fentanyl group compared to the dexmedetomidine group at 0 minutes (7.08 ± 1.03 vs. 6.43 ± 1.33, p = 0.003) and 15 minutes (5.51 ± 1.7 vs. 4.01 ± 1.08, p = 0.0001) postoperative period. The mean time to eye-opening was significantly earlier amongst children receiving fentanyl than those receiving dexmedetomidine (9.3 ± 1.1 min vs. 10.12 ±1.05 min, p = 0.0001). The modified Aldrete Score for adequacy of recovery was statistically insignificant initially, but as the duration progressed to 15 minutes, the children in the fentanyl group had significantly higher scores than those in the dexmedetomidine group (8.05 ± 0.67 vs. 7.76 ± 0.62, p = 0.01).ConclusionProphylactic administration of dexmedetomidine (0.15 mcg/kg) or fentanyl (1 mcg/kg) administered is effective in preventing emergence agitation. Although we found emergence agitation was higher amongst children receiving fentanyl than those receiving dexmedetomidine during the early recovery period, this difference became insignificant as the postoperative period increased to 30 minutes.