Patient-controlled cervical epidural fentanyl compared with patient-controlled i.v. fentanyl for pain after pharyngolaryngeal surgery.
BACKGROUND
Analgesia after pharyngolaryngeal surgery is commonly provided through the i.v. route. The aim of the study was to compare cervical epidural administration of fentanyl with the i.v. route for postoperative analgesia after pharyngolaryngeal surgery.


METHODS
In a randomized double-blind study 42 patients received fentanyl via patient-controlled analgesia (PCA) either through the i.v. route (PCA-IV group, n=22) or through the cervical epidural route (PCA-Epid group, n=20). Identical PCA settings were used in the two groups (bolus dose: 1.5 microg kg(-1), bolus: 25 microg, lockout interval: 10 min, maximum cumulative dose: 400 microg per 4 h). Analgesia at rest and during swallowing was evaluated using a visual analogue scale.


RESULTS
Analgesia at rest was better in the PCA-Epid group than in the PCA-IV group but only 2 and 6 h after surgery (P<0.02). There was no difference in analgesia during swallowing. Cumulative doses of fentanyl were similar {PCA-Epid group: 1412 microg (912), PCA-IV group: 1287 microg (1200) [median (IQR)]}. The Pa(o(2)) showed a significant decrease between the preoperative and postoperative period, but this decrease was identical in the two groups [PCA-IV-group: 11.47 (2.4) kPa vs 8.27 (0.9) kPa; PCA-Epid group: 11.33 (1.9) kPa vs 9.20 (2.4) kPa for preoperative and postoperative period respectively].


CONCLUSIONS
The study results show that cervical epidural analgesia provides marginally better pain relief at rest with no decrease in the fentanyl consumption. The use of the cervical epidural administration of fentanyl is questionable because of the possible complications of the technique.
Département d'Anesthésie-Réanimation, Hôpital Bellevue, Centre Hospitalier et Universitaire de Saint Etienne, 42055 Saint Etienne Cédex 2, France. marc.roussier@chu-st-etienne.fr
M
M
Roussier
P
P
Mahul
J
J
Pascal
D
D
Baylot
J M
JM
Prades
C
C
Auboyer
S
S
Molliex
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural / Q000379:methods*; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D002245:Carbon Dioxide / Q000097:blood; D003679:Deglutition; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D007822:Laryngeal Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy*; D010313:Partial Pressure
D000701:Analgesics, Opioid; D002245:Carbon Dioxide; D010100:Oxygen; D005283:Fentanyl