Intravenous Fentanyl Research Articles

A randomised comparison of transverse abdominal plane block versus thoracic epidural analgesia on postoperative opioid consumption for colorectal enhanced recovery after surgery programme (OPIATE study).

The transverse abdominis plane block is increasingly being used as a less-invasive alternative to thoracic epidural analgesia for effective pain management. This study aimed to compare transverse abdominis plane block with opioid-based thoracic epidural analgesia in terms of postoperative opioid consumption. Patients in the thoracic epidural analgesia group received a continuous infusion of 0.1% levobupivacaine with 2mcg/ml of fentanyl, while those in the transverse abdominis plane group received 6-hourly boluses of 0.4ml/kg of 0.25% levobupivacaine. The primary objective was to compare the average fentanyl consumption, measured as intravenous fentanyl equivalents, over 72 hours. Data of 35 patients were analysed. Fentanyl consumption at the end of 72 hours was significantly lower in the transverse abdominis plane group (median [interquartile range] 495 mcg (255, 750), and mean (95% confidence interval) 717.35mcg (403.54-1031.16)) compared to the thoracic epidural analgesia group (median [interquartile range] 760mcg (750, 760), and mean (95% confidence interval) 787mcg (746.81-827.19)) with a p value of 0.010. Pain scores at rest and during movement were comparable between the groups (p > 0.05). However, the median pain scores during movement were significantly lower in the thoracic epidural analgesia group at 60 and 72 hours (p ⩽ 0.05). Multimodal analgesia with transverse abdominis plane resulted in lower opioid consumption over 72 hours compared to thoracic epidural analgesia.

Comparison of the Effects of Intravenous Fentanyl and Intravenous Dexmedetomidine on Characteristics of Spinal Anesthesia

Comparison of the Effects of Intravenous Fentanyl and Intravenous Dexmedetomidine on Characteristics of Spinal Anesthesia

Use of dexmedetomidine during light versus deep anaesthesia on postoperative delirium among elderly patients undergoing major non-cardiac surgery: protocol for a multicentre randomised factorial trial.

Elderly patients are at a high risk of postoperative delirium (POD), leading to increased postoperative morbidity and mortality. The use of dexmedetomidine and depth of anaesthesia may influence POD. This study aims to determine the effects of dexmedetomidine infusion versus normal saline placebo during light versus deep anaesthesia on POD among elderly patients undergoing major non-cardiac surgery. This prospective, multicentre, randomised, controlled, factorial trial will be conducted at three tertiary hospitals in Jiangsu, China. We will recruit a total of 420 patients who are at least 60 years old and undergoing major non-cardiac surgery (thoracic, abdominal, urology, orthopaedic and spine surgery) under general anaesthesia. Patients will be randomised (1:1:1:1) to receive one of four anaesthesia regimens: (1) dexmedetomidine and light anaesthesia, (2) dexmedetomidine and deep anaesthesia, (3) placebo and light anaesthesia or (4) placebo and deep anaesthesia. Dexmedetomidine will be infused at 0.5 µg/kg/h throughout surgery, and intraoperative bispectral index target will be 55 for light anaesthesia and 40 for deep anaesthesia. The primary outcome is the occurrence of POD during the first 7 days postoperatively or until hospital discharge, assessed using the 3-min Confusion Assessment Method two times per day. The secondary outcomes include days with POD, type of POD, pain scores at rest and on movement at 24 and 48 hours postoperatively, patient-controlled intravenous fentanyl consumption during 0-24 and 24-48 hours postoperatively, hypotension, bradycardia, postoperative nausea and vomiting, non-delirium complications, length of postoperative hospital stay, 30-day cognitive function and 30-day mortality. Data will be analysed on a modified intention-to-treat basis. This trial was approved by the Ethics Committee of the First Affiliated Hospital of Soochow University and each participating centre. The trial results will be published in a peer-reviewed journal. Chinese Clinical Trial Registry (ChiCTR2300073271).

Time Course of Reversal of Fentanyl-Induced Respiratory Depression in Healthy Subjects by Intramuscular Nalmefene and Intramuscular and Intranasal Naloxone.

The increase in opioid overdose deaths, particularly involving potent, long-acting synthetic opioids, has led to calls for stronger, longer-acting opioid-overdose-reversal agents. Using an opioid-induced respiratory depression model, we investigated the onset and time course of action of naloxone and a long-acting opioid antagonist, nalmefene, in reversing the effects of an ongoing intravenous fentanyl infusion over a period of up to 100 min. Healthy, moderately experienced opioid users received intramuscular (IM) nalmefene 1 mg, IM naloxone 2 mg, or intranasal (IN) naloxone 4 mg after fentanyl-induced respiratory depression was established based on reduction in respiratory minute volume (MV). Each participant received each opioid antagonist twice per a randomized crossover schedule. Reversal of respiratory depression, pharmacokinetics, and safety were investigated. Participants showed rapid increases in plasma opioid antagonist concentrations, and meaningful reversal of depressed MV tended to occur earlier with IM nalmefene and IM naloxone than with IN naloxone. Compared to naloxone, nalmefene provided extended exposure, and mean MV was maintained at a higher level. All participants experienced treatment-related adverse events, but none were severe, serious, or led to study drug discontinuation. This study provides evidence that IM nalmefene 1 mg achieves reversal of fentanyl-induced respiratory depression similar to or better than that achieved with standard-of-care naloxone treatments. No new safety concerns were raised for IM nalmefene at the tested dose. The pharmacokinetic and pharmacodynamic properties of IM nalmefene position it as an important treatment option in opioid overdose reversal, particularly given the increasing prevalence of overdoses involving potent, long-acting synthetic opioids.

Aged mice exhibit faster acquisition of intravenous opioid self-administration with variable effects on intake.

Although opioid abuse is more prevalent in young individuals, opioid use, overdose, and use disorders continue to climb at a rapid rate among the elderly. Little is known about abuse potential in a healthy aged population, in part due to technical and logistical difficulties testing intravenous self-administration in aged rodents. The goal of this study was to address the critical gap in the literature regarding age-dependent differences in opioid (remifentanil and fentanyl) self-administration between old and young mice. Male and female mice were grouped into young (mean: 19 weeks) and old (mean: 101 weeks), and were trained to self-administer intravenous fentanyl or remifentanil in daily sessions. In both old and young mice, acquisition, intake, and cue-responding after forced abstinence were measured for both drugs, and a dose-response curve (remifentanil) and dose-escalation (fentanyl) were conducted. Surprisingly, old mice learned to self-administer both remifentanil and fentanyl faster and more accurately than young mice. Baseline intake of remifentanil was also substantially greater in old mice compared to their young counterparts; however, we did not see increased intake of fentanyl with age at either dose tested. Further, compared to young mice, the old mice showed a greater incubation of responding for cues previously associated with remifentanil after a forced abstinence, but again this was not observed with fentanyl. Together these data suggest that an aged population may have an increased drug-abuse vulnerability for opioids compared to young counterparts and underscore the importance of future work on mechanisms responsible for this increased vulnerability.

Does IV fentanyl, frequently used in emergency departments, change QTC value? A prospective observational study

BackgroundFentanyl is an opioid analgesic frequently used in the emergency department (ED) and is usually administered without knowing the QTC values of the patients or being monitored. However, the effect of fentanyl on QTC, prolongation or shortening, has not been elucidated. This study aimed to determine the effect of fentanyl on QTC.MethodsThis is a prospective observational study in the ED of a tertiary hospital on patients who received intravenous fentanyl for procedures other than intubation. ECG was performed before and at 1, 5, 15, 30, and 60 min after the initiation of fentanyl administration, and QTC value was calculated. Primary outcomes were QTC prolongation, defined as an increase in the QTC to ≥ 500 ms or any increase in QTC by ≥ 60 ms.ResultsThe study included 109 patients. Of these, 60 patients were male, and the median age was 40. Compared with the baseline QTC value, statistically significant prolongation was detected at the 5th, 15th, 30th, and 60th minutes, with the maximum prolongation at 30 min, and the median was 13.08 ms. Most patients with QTC prolongation were female and over 40 years of age. Clinically, none of these patients developed malignant arrhythmias during the 60-minute monitored observation period.ConclusionFentanyl prolonged the QTC value statistically significantly. Although no patient developed malignant arrhythmia clinically, our results suggest that this QTC-prolonging effect should be considered when using fentanyl in patients at risk of torsades.

A Comparative Study between Epidural Morphine Bolus and Ropivacaine-fentanyl Infusion in Gastrointestinal Oncosurgeries: A Randomised Clinical Trial (MORFIN Study)

Background and Aims: Epidural local anaesthetic infusion is the gold standard analgesia technique after abdominal surgery. However, hypotension associated with it often leads to the administration of large amounts of fluid, increased vasopressor requirement, reduction of epidural drug dose and thus increased intravenous opioid consumption. Epidural morphine can be an alternative technique. Methods: Eighty-six patients scheduled for open elective gastrointestinal (GI) oncosurgery were enroled in the study. In Group ROP, analgesia was provided with a 6 ml bolus of epidural ropivacaine (0.2%)-fentanyl (2 µg/ml) followed by an infusion at 3–10 ml/h during the perioperative period. In Group MOR, a bolus of epidural morphine 0.05 mg/kg in 10 ml bupivacaine 0.1% was administered every 8–24 h. In both groups, rescue analgesia was provided with intravenous fentanyl. The primary outcome of the study was to compare post-operative fentanyl consumption between the two groups. Results: Mean ± standard deviation (95% confidence interval) fentanyl consumption was significantly lower in Group MOR in the first 24 h (92 ± 191 [33, 151] vs. 255 ± 263 [173, 338] µg in Group ROP; P < 0.01), 24–48 h (71 ± 203 [9, 134] in Group MOR vs. 261 ± 357 [150, 372] in Group ROP; P < 0.001) and 48–72 h (51 ± 168 [0, 103] in Group MOR vs. 240 ± 319 [140, 339] in Group ROP; P < 0.001) in the post-operative period. Pain scores at rest and during movement were significantly lower in group MOR in the immediate post-operative period. The post-operative fluid requirement in the first 24 h was also significantly lower. Conclusion: Intermittent boluses of epidural morphine with low-dose bupivacaine are associated with lesser post-operative fentanyl consumption compared to epidural ropivacaine-fentanyl infusion after GI oncosurgery.

Perioperative Analgesic and Sedative Effects of Cannabidiol in Cats Undergoing Ovariohysterectomy.

The aim of this study was to evaluate the perioperative analgesic and sedative effects of oral CBD in cats undergoing ovariohysterectomy. Twenty-two cats were assigned to receive either oral cannabidiol oil (2 mg/kg, CBD group, n = 12) or placebo oil (0.1 mL/kg, Placebo group, n = 10) 60 min before the premedication. The anesthetic protocol included dexmedetomidine/meperidine, propofol, and isoflurane. Intravenous fentanyl was given to control cardiovascular responses to surgical stimulation. Pain was assessed at 0.5, 1, 2, 4, 6 and 8 h post-extubation using the UNESP-Botucatu multidimensional composite pain scale and the Glasgow feline composite-measure pain scale. Sedation scores were assessed at the same timepoints and at 15 min after the premedication. Morphine was administered as rescue analgesia. Higher sedation scores were recorded in the CBD group at 15 min after premedication (p = 0.041). Intraoperatively, more cats required fentanyl in the Placebo group than in CBD group (p = 0.028). The pain scores did not differ between groups, except at 0.5 h post-extubation when lower scores were detected in the CBD group (p = 0.003-0.005). Morphine was required in 100% of the animals in both groups. CBD increased preoperative sedation and decreased intraoperative analgesic requirements, with minimal evidence of postoperative analgesic benefits over the placebo.

Bioabsorbable, subcutaneous naltrexone implants mitigate fentanyl-induced respiratory depression at 3 months-A pilot study in male canines.

The aim of this study is to determine if extended-release, bioabsorbable, subcutaneous naltrexone (NTX) implants can mitigate respiratory depression after an intravenous injection (IV) of fentanyl. Six different BIOabsorbable Polymeric Implant Naltrexone (BIOPIN) formulations, comprising combinations of Poly-d,l-Lactic Acid (PDLLA) and/or Polycaprolactone (PCL-1 or PCL-2), were used to create subcutaneous implants. Both placebo and naltrexone implants were implanted subcutaneously in male dogs. The active naltrexone implants consisted of two doses, 644 mg and 1288 mg. A challenge with IV fentanyl was performed in 33 male dogs at 97-100 days after implantation. Following the administration of a 30 μg/kg intravenous fentanyl dose, the placebo cohort manifested a swift and profound respiratory depression with a ~50% reduction in their pre-dose respiratory rate (RR). The BIOPIN NTX-implanted dogs were exposed to escalating doses of intravenous fentanyl (30 μg/kg, 60 μg/kg, 90 μg/kg, and 120 μg/kg). In contrast, the dogs implanted with the BIOPIN naltrexone implants tolerated doses up to 60 μg/kg without significant respiratory depression (<50%) but had severe respiratory depression with fentanyl doses of 90 μg/kg and especially at 120 μg/kg. Bioabsorbable, extended-release BIOPIN naltrexone implants are effective in mitigating fentanyl-induced respiratory depression in male canines at about 3 months after implantation. This technology may also have potential for mitigating fentanyl-induced respiratory depression in humans.

Live birth after transmyometrial embryo transfer in a patient with radical trachelectomy

ObjectiveTo report the successful utilization of transmyometrial embryo transfer (TMET) in a patient with a history of radical trachelectomy. DesignVideo article. SettingAcademic fertility center. Subject(s)A 39-year-old, para 1, woman with a history of radical trachelectomy and abdominal cerclage presented with secondary infertility. Her prior pregnancy was conceived naturally. Her first in vitro fertilization (IVF) cycle yielded only one day-7 euploid blastocyst. All attempts at performing mock embryo transfers, cervical dilatation and hysteroscopy were unsuccessful due to absence of clinically identifiable cervical tissue. The euploid embryo was transferred into a gestational carrier; however, this resulted in a biochemical pregnancy. She underwent a second IVF cycle that yielded one day-5 euploid blastocyst. Given her history, TMET was planned. The patient included in this video gave consent for publication of the video and posting of the video online including social media, the journal website, scientific literature websites (such as PubMed, ScienceDirect, Scopus, etc.) and other applicable sites. InterventionTMET using the Towako® catheter. Main Outcome MeasuresImplantation, clinical pregnancy and live birth. ResultsFollowing institutional and Health Canada approval of the Towako® catheter, a transvaginal-ultrasound guided TMET was performed under sedation with intravenous midazolam and fentanyl. The day-5 euploid blastocyst from the second IVF cycle was transferred and the patient’s β-human chorionic gonadotropin (β-hCG) levels 9 and 11 days after TMET were 86 IU/L and 262 IU/L, respectively. A single intrauterine pregnancy with cardiac activity of 119 beats/min was noted at a gestational age of 7 weeks and 2 days. The patient delivered a live singleton at 35 weeks and 2 days weighing 2182 grams. ConclusionTMET is a useful clinical technique for transferring embryos in patients with acquired or congenital cervical issues in whom trans-cervical embryo transfer is either very difficult or impossible.

Efficacy and Safety of Intrathecal Morphine for Cesarean Delivery: A Narrative Review.

Pain management is a critical aspect of care during and following a cesarean delivery. Without proper control of pain, individuals can experience poor mobility, increased thromboembolic events, and difficulty caring for the neonate in the postpartum period. There have been multiple methods for pain management for cesarean delivery and intrathecal morphine (ITM) has emerged as a prominent option for post-operative analgesia due to its efficacy, safety, and potential benefits over other treatments. This review analyzes data on efficacy, side effects, and safety of ITM and the pain control alternatives. A comprehensive literature review was conducted to compare ITM with other analgesic techniques in post-cesarean patients. ITM was found to be as effective or better than other analgesic options, including bilateral quadratus lumborum block (QLB), opioid-free epidural analgesia (CSEA-EDA), and intravenous fentanyl. One study found that both ITM and oral analgesia were effective in pain control and that ITM caused fewer breakthrough pain events but had a longer duration and a greater rate of side effects than oral opioid analgesia. Commonly observed side effects of intrathecal opioids include nausea, vomiting, pruritus, and urinary retention, and it is thought that the adverse effects from intrathecal administration of opioids are short-lived. ITM may provide a decreased risk of DVT and coagulation by decreasing lower extremity weakness and numbness, thereby decreasing recovery time and increasing mobility. ITM is a safe and effective option for post-cesarean analgesia, with comparable pain relief to alternative forms of pain control, and side effects that are generally manageable. Further research is warranted to explore beneficial combinations with other methods of pain management and optimal dosing strategies.

Effect of Fentanyl Compared to Morphine on Pain Score and Cardiorespiratory Vital Signs in Out-of-Hospital Adult STEMI Patients

Objective: ST-elevation myocardial infarction (STEMI) is a leading cause of mortality in Australia. Paramedics treating adults with STEMI in the out-of-hospital environment can use fentanyl or morphine to manage the patient’s pain, although there is little research comparing the efficacy and safety of these drugs. Therefore, the objective of this study was to compare the effects of fentanyl to morphine on cardiac chest pain and cardiorespiratory vital signs in adult STEMI patients in the out-of-hospital environment. Methods: We conducted a retrospective analysis of records of 1902 STEMI cases attended by Queensland Ambulance Service paramedics during the 4-year interval from 2013 to 2016. We compared pain score, blood pressure, respiratory rate, and pulse rate between patients administered intravenous fentanyl and intravenous morphine. We used a two-way mixed effects model (drug, time) to assess for main and interaction effects, and where the interaction effect was significant, applied Mann-Whitney U tests to further analyze between-group differences at each time point. Results: We observed a significant main effect of time on pain score (p &lt; 0.001), respiratory rate (p &lt; 0.05), and pulse rate (p = 0.025), such that these variables all decreased over time. Additionally, we observed a significant drug-time interaction for systolic and diastolic blood pressures (both p &lt; 0.01), such that blood pressures decreased over time in the morphine, but not fentanyl, group. Conclusion: We compared the effects of fentanyl to morphine on cardiac chest pain and cardiorespiratory vital signs in out-of-hospital adult STEMI patients and observed differences in blood pressures only. Morphine appeared to have a depressive effect on systolic and diastolic blood pressure, whereas fentanyl did not. An unanticipated behavioural finding of this research is that, in the absence of a definitive guideline, paramedics appear to use fentanyl when patients may be at risk of developing hypotension.

EARLY ACTIVATION PATHWAYS IN PATIENTS UNDERGOING OPEN HEART SURGERY WITH MULTICOMPONENT GENERAL ANESTHESIA COMBINED WITH HIGH THORACIC EPIDURAL ANESTHESIA

Background: Early mobilization of patients in the postoperative period after open heart surgeries, significantly decreases the risk of complications, accelerates the restoration of functional capacity, shortens the length of hospital stay, and reduces treatment costs Materials and methods: Open heart surgeries were performed on 60 patients at Ankara "Bayındır" Hospital, Central Clinical Hospital, and Baku Health Center were included in the study. Patients were divided into two groups. 30 of them underwent the procedure with the use of multi-component balanced general anesthesia and intravenous fentanyl analgesia in the postoperative period. The other group of 30 patients underwent catheterization under high thoracic epidural anesthesia, with the administration of ropivacaine prior to induction and, in the postoperative period, ropivacaine and fentanyl. We conducted a study on central hemodynamic parameters and analgesic effects. Results: Thirty of them underwent the procedure with the use of multi-component general anesthesia and intravenous fentanyl analgesia in the postoperative period. The other group of 30 patients underwent catheterization of the high epidural space with the administration of ropivacaine before induction and, in the postoperative period, ropivacaine and fentanyl. We conducted a study on central hemodynamic parameters and analgesic effects. Conclusion: It has been established that for patients in the second group according to the Enhanced Recovery After Surgery strategy, hemodynamic support and effective pain management can contribute to early patient mobilization after surgery. Early mobilization, in turn, can expedite recovery and reduce the length of hospital stay, ultimately leading to potential cost savings.

Comparative Analysis of Nebulized Versus Intravenous Fentanyl for Pain Control After Tonsillectomy: A Double-Blind, Randomized, Controlled Trial.

Effective posttonsillectomy analgesia is crucial for patient comfort and recovery. Fentanyl, notable for its potency, rapid action, and lipophilicity, has been successfully used in various procedures through multiple administration routes. However, the use of its nebulized form for posttonsillectomy pain has not been extensively explored. This study sought to compare the analgesic efficacy, onset time, and complications between nebulized and intravenous fentanyl in posttonsillectomy patients. In this randomized controlled trial, adult patients who underwent tonsillectomy were assigned to either an intravenous fentanyl group (1 mcg/kg) or a nebulized fentanyl group (4 mcg/kg). In both groups, fentanyl was administered when pain scores exceeded three. Pain levels were monitored every 5 minutes until they fell below four. The study also recorded the duration until the next analgesia request and noted complications (such as respiratory depression, bradycardia, chest tightness, drowsiness, nausea, pruritus, sweating, and flushing) within 24 hours. Patient exclusions were based on predetermined criteria. From an initial cohort of 59 patients, 22 in the intravenous group and 27 in the nebulizer group were eligible for analysis after applying the exclusion criteria. The nebulizer group exhibited a significantly prolonged period before the next analgesia request, with a median of 683.5 minutes (interquartile range 260-1440), in contrast to the 326.7 minutes (145.0-504.7) observed in the intravenous group (P = .009). The time to achieve a pain score less than 4 and the incidence of side effects did not differ significantly between the groups. Nebulized fentanyl provided a longer duration of analgesia than intravenous fentanyl in posttonsillectomy pain management, with similar onset times and side effect profiles. These findings underscore the potential of nebulized fentanyl as an effective alternative for pain control in posttonsillectomy patients.

Oxygen fluctuations in the brain and periphery induced by intravenous fentanyl: effects of dose and drug experience.

Fentanyl is the leading contributor to drug overdose deaths in the United States. Its potency, rapid onset of action, and lack of effective reversal treatment make the drug much more lethal than other opioids. Although it is understood that fentanyl is dangerous at higher doses, the literature surrounding fentanyl's physiological effects remains contradictory at lower doses. To explore this discrepancy, we designed a study incorporating electrochemical assessment of oxygen in the brain (nucleus accumbens) and subcutaneous space, multisite thermorecording (brain, skin, muscle), and locomotor activity at varying doses of fentanyl (1.0, 3.0, 10, 30, and 90 µg/kg) in rats. In the nucleus accumbens, lower doses of fentanyl (3.0 and 10 µg/kg) led to an increase in oxygen levels while higher doses (30 and 90 µg/kg) led to a biphasic pattern, with an initial dose-dependent decrease followed by an increase. In the subcutaneous space, oxygen decreases started to appear at relatively lower doses (>3 µg/kg), had shorter onset latencies, and were stronger and prolonged. In the temperature experiment, lower doses of fentanyl (1.0, 3.0, and 10 µg/kg) led to an increase in brain, skin, and muscle temperatures, while higher doses (30 and 90 µg/kg) resulted in a dose-dependent biphasic temperature change, with an increase followed by a prolonged decrease. We also compared oxygen and temperature responses induced by fentanyl over six consecutive days and found no evidence of tolerance in both parameters. In conclusion, we report that fentanyl's effects are highly dose-dependent, drawing attention to the importance of better characterization to adequately respond in emergent cases of illicit fentanyl misuse.NEW & NOTEWORTHY By using electrochemical oxygen sensors in freely moving rats, we show that intravenous fentanyl induces opposite changes in brain oxygen at varying doses, increasing at lower doses (<10 µg/kg) and inducing a biphasic response, decrease followed by increase, at higher doses (>10-90 µg/kg). In contrast, fentanyl-induced dose-dependent oxygen decreases in the subcutaneous space. We consider the mechanisms underlying distinct oxygen responses in the brain and periphery and discuss naloxone's role in alleviating fentanyl-induced brain hypoxia.

Intravenous Opioid Administration During Mechanical Ventilation and Use After Hospital Discharge

Guidelines recommend an analgesia-first strategy for sedation during mechanical ventilation, but associations between opioids provided during mechanical ventilation and posthospitalization opioid-related outcomes are unclear. To evaluate associations between an intravenous opioid dose received during mechanical ventilation and postdischarge opioid-related outcomes in medical (nonsurgical) patients. This retrospective cohort study evaluated adults receiving mechanical ventilation lasting 24 hours or more for acute respiratory failure and surviving hospitalization. Participants from 21 Kaiser Permanente Northern California hospitals from January 1, 2012, to December 31, 2019, were included. Data were analyzed from October 1, 2020, to October 31, 2023. Terciles of median daily intravenous fentanyl equivalents during mechanical ventilation. The primary outcome was the first filled opioid prescription in 1 year after discharge. Secondary outcomes included persistent opioid use and opioid-associated complications. Secondary analyses tested for interaction between opioid doses during mechanical ventilation, prior opioid use, and posthospitalization opioid use. Estimates were based on multivariable-adjusted time-to-event analyses, with death as a competing risk, and censored for hospice or palliative care referral, rehospitalization with receipt of opioid, or loss of Kaiser Permanente plan membership. The study included 6746 patients across 21 hospitals (median age, 67 years [IQR, 57-76 years]; 53.0% male). Of the participants, 3114 (46.2%) filled an opioid prescription in the year prior to admission. The median daily fentanyl equivalent during mechanical ventilation was 200 μg (IQR, 40-1000 μg), with terciles of 0 to 67 μg, more than 67 to 700 μg, and more than 700 μg. Compared with patients who did not receive opioids during mechanical ventilation (n = 1013), a higher daily opioid dose was associated with opioid prescriptions in the year after discharge (n = 2942 outcomes; tercile 1: adjusted hazard ratio [AHR], 1.00 [95% CI, 0.85-1.17], tercile 2: AHR, 1.20 [95% CI, 1.03-1.40], and tercile 3: AHR, 1.25 [95% CI, 1.07-1.47]). Higher doses of opioids during mechanical ventilation were also associated with persistent opioid use after hospitalization (n = 1410 outcomes; tercile 3 vs no opioids: odds ratio, 1.44 [95% CI, 1.14-1.83]). No interaction was observed between opioid dose during mechanical ventilation, prior opioid use, and posthospitalization opioid use. In this retrospective cohort study of patients receiving mechanical ventilation, opioids administered during mechanical ventilation were associated with opioid prescriptions following hospital discharge. Additional studies to evaluate risks and benefits of strategies using lower opioid doses are warranted.

Effect of single-dose intravenous lignocaine versus fentanyl on neuromuscular recovery time after general anesthesia in elective pediatric surgery: A randomized controlled pilot study

Abstract Background and Aims: Intravenous (IV) lignocaine is often used to prevent the airway response to extubation, especially in children to prevent respiratory adverse events. It is known to prolong the duration of action of neuromuscular blocking drugs, but data in children are limited. The primary objective of this study was to compare neuromuscular recovery time with IV lignocaine versus fentanyl, in pediatric patients undergoing elective surgery under general anesthesia (GA). Secondary objectives included the comparison of clinical parameters and respiratory complications. Material and Methods: A randomized double-blind pilot study was conducted in 42 children aged 2–8 years undergoing GA with neuromuscular blockade, who received either 1.5 mg/kg of lignocaine or 0.5 mcg/kg of fentanyl IV, just prior to giving reversal at a train of four (TOF) count of 2–3. Time to achieve a TOF ratio of 0.9 and extubation and hemodynamic and respiratory parameters were noted. Incidences of coughing, bucking, laryngospasm, etc., were also noted. P value &lt; 0.05 was considered significant. Results: Demographic and operative data were similar. Time from reversal to TOF ratio of 0.9 was similar with both lignocaine (6.79 ± 3.03 mins) and fentanyl (6.79 ± 3.31 mins), P = 0.99. Time to extubation was also similar in both groups (8.14 ± 3.31 vs 9.19 ± 2.89 min), P = 0.28. Bucking incidence was higher with fentanyl (23.8%) vs lignocaine (9.5%), P = 0.41. Conclusions: Single-dose IV lignocaine administered before reversal did not prolong neuromuscular recovery time compared to fentanyl, with a similar (low) incidence of respiratory events in pediatric patients.

RANDOMIZED TRIAL FOR COMPARISON OF BUPRENORPHINE AND FENTANYL FOR AWAKE FIBEROPTIC INTUBATION

Objectives: Awake fiberoptic intubation (AFOI) is a step-forward technique for successful intubation of patients with difficult airways. The popularity of its usage is increasing day by day in handling difficult airways. Our study aims to compare the efficacy and efficiency of Buprenorphine and Fentanyl as sedative agents for AFOI. The primary and secondary outcome measure was to assess hemodynamic response and on intubating condition of the patient after AFOI. Methods: This randomized, prospective study was conducted in tertiary Center hospital. Total of 100 patient were enrolled for study and divided into two groups, Group A patients received intravenous Buprenorphine injection (2.5 (microgram/kilogram [μg/kg] over 10 min) and Group B Fentanyl injection (2 μg/kg over10 min) was injected prior to AFOI. The degree of sedation was assessed using the Observer’s assessment of alertness/sedation score (OAA/S), and the score of coughing during awake bronchoscopy was used to assess intubation status. Tolerability of intubation was assessed using a 5-point intubation score and a 3-point post-intubation assessment score immediately after the placement of the endotracheal tube into the trachea. Results: Group A had more favorable OAA score than Group B, whereas other intubation conditions cough score, limb movement, 5-point intubation score, 3-point post intubation score was more favourable in Group B than in Group A. Conclusion: Intravenous Fentanyl is better than Buprenorphine agent in terms of intubation score for AFOI. Both groups are comparable in terms of hemodynamic changes and stability.

Major Pelvic Ortho-oncological Surgeries: Our Experience

Background and Aims: Anaesthesia for pelvic tumour surgeries is challenging because of major blood loss, extensive tissue damage, hypothermia due to the longer duration of surgery, unusual and frequent change in positions, ongoing postoperative blood loss and post-operative pain management. This retrospective study aimed to assess the perioperative anaesthetic management for patients undergoing major pelvic tumour surgeries in our institute. Methods: We collected data from 20 patients from the patient files, anaesthesia records and electronic medical records about demographics, type and duration of surgery, pre-operative morbidities, preoperative chemotherapy/radiotherapy, intraoperative anaesthesia management with respect to fluids, blood loss, blood products transfused and postoperative pain management and complications. Data were summarised using percentages for categorical data and medians for continuous data. Results: Sixteen patients were given epidural and general anaesthesia, while four were given only general anaesthesia. The median duration of surgery was 7 h (interquartile range [IQR] 5–10 h). Multiple surgeons were involved in four cases. The median blood loss was 1500 ml (IQR 550–2750 mL); nine patients needed massive blood transfusions. Navigation-guided surgical cuts were made in eight patients. Three required postoperative mechanical ventilation. The pain was managed by epidural infusions and intravenous patient-controlled fentanyl infusions. The postoperative complication was seen in two patients in the form of wound infection and a post-operative bleed. Conclusion: The major pelvic orthopaedic oncological surgeries require meticulous attention to patient-centric perioperative care. A dedicated team approach with a definitive surgical plan, anticipating complications and their timely intervention, pain management and postoperative rehabilitation can lead to improved outcomes.

Transcriptional signatures of fentanyl use in the mouse ventral tegmental area.

Synthetic opioids such as fentanyl contribute to the vast majority of opioid-related overdose deaths, but fentanyl use remains broadly understudied. Like other substances with misuse potential, opioids cause lasting molecular adaptations to brain reward circuits, including neurons in the ventral tegmental area (VTA). The VTA contains numerous cell types that play diverse roles in opioid use and relapse; however, it is unknown how fentanyl experience alters the transcriptional landscape in specific subtypes. Here, we performed single nuclei RNA sequencing to study transcriptional programs in fentanyl-experienced mice. Male and female C57/BL6 mice self-administered intravenous fentanyl (1.5μg/kg/infusion) or saline for 10days. After 24 h abstinence, VTA nuclei were isolated and prepared for sequencing on the 10× platform. We identified different patterns of gene expression across cell types. In dopamine neurons, we found enrichment of genes involved in growth hormone signalling. In dopamine-glutamate-GABA combinatorial neurons, and some GABA neurons, we found enrichment of genes involved in Pi3k-Akt signalling. In glutamate neurons, we found enrichment of genes involved in cholinergic signalling. We identified transcriptional regulators for the differentially expressed genes in each neuron cluster, including downregulated transcriptional repressor Bcl6, and upregulated transcription factor Tcf4. We also compared the fentanyl-induced gene expression changes identified in mouse VTA with a published rat dataset in bulk VTA, and found overlap in genes related to GABAergic signalling and extracellular matrix interaction. Together, we provide a comprehensive picture of how fentanyl self-administration alters the transcriptional landscape of the mouse VTA that serves as the foundation for future mechanistic studies.