title: The effect of fentanyl administered epidurally by patient-controlled analgesia, continuous infusion, or a combined technique of oxyhaemoglobin saturation after abdominal surgery.
abstract: The aims of this study were to determine the effect of three different modes of epidural administration of fentanyl on oxyhaemoglobin saturation and pain control. Forty-three patients undergoing elective abdominal surgery were randomly allocated to the following groups: (1) continuous infusion of fentanyl at a rate of 50 micrograms.h-1 with additional epidural boluses (25 micrograms) as required; (2) patient-controlled analgesia using a 25 microgram epidural bolus of fentanyl with a 15 min lock-out period; (3) a combination of patient-controlled analgesia and continuous infusion. Oxyhaemoglobin saturation was measured by continuous computerised pulse oximetry for 48 h after operation together with pain and sedation scores. In the first 24 h after surgery patients in the continuous infusion group spent a significantly greater proportion of time below oxygen saturations of 94% and 85% than those in the other two groups. On day 2 all oxygen saturation measurements were worse than during day 1, but differences between groups were not significant. Those patients receiving patient-controlled analgesia required significantly less fentanyl than patients in either of the other groups (p < 0.05). However, the mean pain and sedation scores did not differ significantly between the three treatment groups. There was no association between total fentanyl dose and oxygen saturation values. Overall, self-administered fentanyl appeared to cause less oxyhaemoglobin desaturation than nurse-administered analgesia without any loss of analgesic effect.
authors.affiliation: Department of Anaesthesia and Intensive Care, Flinders Medical Centre, Bedford Park, South Australia.
authors.forename: H
authors.initials: H
authors.lastname: Owen
authors.forename: M T
authors.initials: MT
authors.lastname: Kluger
authors.forename: A H
authors.initials: AH
authors.lastname: Ilsley
authors.forename: A M
authors.initials: AM
authors.lastname: Baldwin
authors.forename: R R
authors.initials: RR
authors.lastname: Fronsko
authors.forename: J L
authors.initials: JL
authors.lastname: Plummer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D007263:Infusions, Parenteral; D007268:Injections, Epidural; D008875:Middle Aged; D010108:Oxyhemoglobins / Q000032:analysis*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000097:blood / Q000188:drug therapy*
chemical_list: D010108:Oxyhemoglobins; D005283:Fentanyl