title: The effectiveness of continuous epidural infusion of low-dose fentanyl and mepivacaine in perioperative analgesia and hemodynamic control in mastectomy patients.
abstract: OBJECTIVE
  To investigate, in mastectomy patients, the effectiveness of continuous cervical epidural block using a low-dose fentanyl infusion in combination with local anesthetics.
  
  
  METHODS
  Prospective, observational study.
  
  
  METHODS
  450-bed, university-affiliated hospital.
  
  
  METHODS
  21 ASA physical status I and II female patients undergoing modified radical mastectomy.
  
  
  METHODS
  An epidural catheter was inserted at the C(7)-Th(1) interspace before the induction of anesthesia. Anesthesia was maintained using a low concentration of sevoflurane with nitrous oxide-oxygen (N(2)O-O(2)). A mixture of 100 microg fentanyl and 49 mL of 1% mepivacaine was prepared, and 7 mL of this solution was epidurally injected before the initial incision. This same solution was continuously infused at a rate of 7 mL/hr (fentanyl 17.5 microg/hr) throughout the anesthesia, and at 2 mL/hr (fentanyl 5 microg/hr) postoperatively.
  
  
  RESULTS
  Intraoperative mean arterial pressure (MAP) and heart rate (HR), postoperative pain and analgesic use, and the frequency of postoperative side effects of anesthesia, including nausea, dizziness, and respiratory depression, were recorded. The protocol described provided stable intraoperative hemodynamic control with no or low-dose nicardipine infusion. Sufficient postoperative analgesia was achieved in 18 of 21 patients. One patient reported postoperative nausea, and no other side effects were reported.
  
  
  CONCLUSIONS
  Continuous epidural infusion of the low-dose fentanyl mixture described above provides adequate intraoperative hemodynamic control and postoperative pain relief, with a low rate of side effects in mastectomy patients.
authors.affiliation: Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan. ykotake@sc.itc.keio.ac.jp
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Kotake
authors.forename: Midori
authors.initials: M
authors.lastname: Matsumoto
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Morisaki
authors.forename: Junzo
authors.initials: J
authors.lastname: Takeda
mesh_terms: D015360:Analgesia, Epidural; D000768:Anesthesia, General; D019162:Anesthetics, Combined; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001794:Blood Pressure; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006339:Heart Rate; D006801:Humans; D015411:Mastectomy, Modified Radical; D008619:Mepivacaine / Q000008:administration & dosage*; D008738:Methyl Ethers; D008875:Middle Aged; D009609:Nitrous Oxide; D010149:Postoperative Pain / Q000188:drug therapy / Q000517:prevention & control*; D020250:Postoperative Nausea and Vomiting; D000077149:Sevoflurane
chemical_list: D019162:Anesthetics, Combined; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D008738:Methyl Ethers; D000077149:Sevoflurane; D008619:Mepivacaine; D009609:Nitrous Oxide; D005283:Fentanyl