title: Extradural fentanyl for postoperative analgesia: predominant spinal or systemic action?
abstract: This randomized, double-blind study of 40 patients was designed to determine if the predominant analgesic effect of extradural fentanyl is mediated by a direct spinal action or an indirect systemic one. After Caesarean section, postoperative analgesia was provided for 24 h by patient-controlled extradural analgesia (PCEA group) or by patient-controlled i.v. analgesia (PCIVA group). Both groups received a bolus dose of fentanyl 20 micrograms with a 10-min lockout interval. In the PCIVA group, nine patients stopped early (compared with none in the PCEA group) because of inadequate analgesia. Mean visual analogue pain scores (0-100 mm) at 8 and 12 h were lower for PCEA (23 (sd 13) mm at rest, 31 (23) mm on coughing) than for PCIVA (50 (25) mm at rest, 67 (24) mm on coughing) (P < 0.0005). The mean dose of fentanyl self-administered between 4 and 8 h was lower in the PCEA group (38 (sd 30) micrograms h-1) compared with the PCIVA group (59 (27) micrograms h-1) (P < 0.05). Our results support the hypothesis that the predominant analgesic effect of extradural administration of fentanyl is mediated by a direct spinal action rather than an indirect action from systemic absorption.
authors.affiliation: Department of Anaesthetics, South Cleveland Hospital, Middlesbrough.
authors.forename: D W
authors.initials: DW
authors.lastname: Cooper
authors.forename: D M
authors.initials: DM
authors.lastname: Ryall
authors.forename: W R
authors.initials: WR
authors.lastname: Desira
mesh_terms: D000293:Adolescent; D000328:Adult; D015360:Analgesia, Epidural; D016362:Analgesia, Obstetrical; D016058:Analgesia, Patient-Controlled; D002585:Cesarean Section; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D007275:Injections, Intravenous; D010149:Postoperative Pain / Q000517:prevention & control*; D011247:Pregnancy
chemical_list: D005283:Fentanyl