title: Epidural vs. intravenous fentanyl during colorectal surgery using a double-blind, double-dummy design.
abstract: BACKGROUND
  The overall therapeutic effectiveness of epidural fentanyl vs. the intravenous route is controversial. The present work describes a randomized, controlled, double-blind, double-dummy study of the intraoperative requirements of fentanyl administered by the intravenous or epidural routes during open colon surgery.
  
  
  METHODS
  Thirty patients were randomized to receive intraoperative analgesia with boluses of fentanyl administered by either the epidural or intravenous route (2 μg/kg). The first fentanyl bolus was administered 10 min before incision, and repeated boluses were given when mean arterial pressure or heart rate increased more than 20% over basal values. General anaesthesia was maintained with a propofol infusion. Intraoperative fentanyl and propofol requirements, time to awakening, time to analgesia request, and incidence of adverse effects were recorded.
  
  
  RESULTS
  Median [interquartile range (range)] fentanyl requirements in the epidural and intravenous groups were 0.81 [0.65 (0.47-2.61)] and 2.5 [1.08 (1.07-4.85)] μg/kg/h, respectively (P < 0.001). The epidural group had a shorter time to awakening, with a median of 8 min [4.5 (3-18)] compared with 20 min [12.5 (7-34)] for the intravenous group (P < 0.001). There were no significant differences in propofol requirements. The time to analgesia request was also delayed in the epidural group, with a median of 5 h [5.5 (1-16)] vs. 2 h [1 (1-5)] when fentanyl was administered intravenously (P < 0.001). The incidence of adverse effects was similar in both groups.
  
  
  CONCLUSIONS
  During major abdominal surgery, epidural administration requires lower doses of intraoperative fentanyl when compared with the intravenous route. Epidural fentanyl also facilitates early awakening and residual analgesia without increasing adverse events.
authors.affiliation: Consorci Parc de Salut Mar, Hospital del Mar, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Sadurní
authors.forename: S
authors.initials: S
authors.lastname: Beltrán de Heredia
authors.forename: C
authors.initials: C
authors.lastname: Dürsteler
authors.forename: A
authors.initials: A
authors.lastname: Pérez-Ramos
authors.forename: K
authors.initials: K
authors.lastname: Langohr
authors.forename: F
authors.initials: F
authors.lastname: Escolano
authors.forename: M M
authors.initials: MM
authors.lastname: Puig
mesh_terms: D000368:Aged; D015360:Analgesia, Epidural / Q000379:methods*; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D000768:Anesthesia, General; D000771:Anesthesia, Intravenous / Q000379:methods*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage* / Q000009:adverse effects; D003106:Colon / Q000601:surgery*; D003110:Colonic Neoplasms / Q000601:surgery; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage* / Q000009:adverse effects; D005500:Follow-Up Studies; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D016343:Monitoring, Intraoperative; D010149:Postoperative Pain / Q000188:drug therapy; D015742:Propofol / Q000008:administration & dosage; D012007:Rectum / Q000601:surgery*; D018401:Sample Size
chemical_list: D000701:Analgesics, Opioid; D018686:Anesthetics, Intravenous; D005283:Fentanyl; D015742:Propofol