title: Analgesia and side effects of the addition of 10 or 20 µg fentanyl to articaine in spinal anesthesia for knee arthroscopy: a randomized and observer-blinded study.
abstract: OBJECTIVE
  Articaine, a popular and rapidly acting local anesthetic in dentistry, has been also found to be beneficial in ambulatory spinal anesthesia. Analgesia in the intraoperative and immediate postoperative period may be further improved by adding fentanyl to the local anesthetic solution for spinal anesthesia. The aim was to evaluate dose-dependency of analgesia and side effects associated with intrathecal fentanyl additive to articaine for spinal anesthesia in knee arthroscopy patients.
  
  
  METHODS
  In this randomized, observer- and patient-blinded study, 90 adult patients scheduled for elective ambulatory knee arthroscopy under spinal anesthesia were randomized into three groups: plain articaine 60 mg with saline (group AF0), articaine 60 mg with fentanyl 10 µg (group AF10) or 20 µg (group AF20) in a total volume of 1.9 ml. The blinded observer tested the sensory and the motor block, and performed telephone interviews on the first and seventh postoperative days.
  
  
  RESULTS
  The median (IQR) duration of sensory block at the dermatomal level of T10 was significantly longer in groups AF10, 69 min (56) and AF20, 69 min (45) than in group AF0, 41 min (35) (p = 0.013). Motor block duration was similar in all groups (median 120 min). Group AF20 patients experienced pruritus significantly more often than patients in the other groups (p = 0.039). No acute or late anesthetic side effects occurred, and satisfaction with the anesthetic technique was the same in all groups (97% satisfied).
  
  
  CONCLUSIONS
  Fentanyl 10 or 20 µg as additive to articaine for spinal anesthesia prolonged the duration of sensory block significantly and similarly. Fentanyl 20 µg was more often associated with pruritus than fentanyl 10 µg.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Töölö Hospital, Helsinki University Hospital, PO Box 266, 00029, Helsinki, Finland.
authors.forename: Paula
authors.initials: P
authors.lastname: Stenman
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Töölö Hospital, Helsinki University Hospital, PO Box 266, 00029, Helsinki, Finland.
authors.forename: Merja
authors.initials: M
authors.lastname: Salonen
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Töölö Hospital, Helsinki University Hospital, PO Box 266, 00029, Helsinki, Finland. pekka.tarkkila@hus.fi.
authors.forename: Pekka
authors.initials: P
authors.lastname: Tarkkila
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Helsinki University, Biomedicum Helsinki 2C, PO Box 705, 00029, Helsinki, Finland.
authors.forename: Per
authors.initials: P
authors.lastname: Rosenberg
mesh_terms: D000328:Adult; D000698:Analgesia / Q000379:methods; D000775:Anesthesia, Spinal / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects; D001182:Arthroscopy / Q000379:methods*; D002355:Carticaine / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D008297:Male; D008875:Middle Aged; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D002355:Carticaine; D005283:Fentanyl
keywords: Day-case spinal anesthesia; Local anesthetic articaine; Postoperative pruritus; Subarachnoid fentanyl additive