Korean J Anesthesiol.  2013 Dec;65(6):544-551. 10.4097/kjae.2013.65.6.544.

The efficacy of the time-scheduled decremental continuous infusion of fentanyl for postoperative patient-controlled analgesia after total intravenous anesthesia

• Kim JY
• Park SY
• Chang HS
• Nam SK
• Min SK

• KMID: 2092381
• DOI: http://doi.org/10.4097/kjae.2013.65.6.544

Abstract

BACKGROUND
Intravenous fentanyl has been used for acute postoperative pain management, but has not always provided reliable adequate analgesia, including patient-controlled analgesia (PCA). The purpose of this study was to investigate the efficacy of time-scheduled decremental infusion of fentanyl for postoperative analgesia.
METHODS
Ninety-nine patients, aged 20-65 years, undergoing laparoscopic-assisted hysterectomy using total intravenous anesthesia (TIVA) were randomly assigned into one of the three groups. Their background infusions of fentanyl diluent (2 ml/hr of diluent was equivalent with 0.5 microg/kg/hr of fentanyl) with PCA were maintained at the fixed-rate of 2 ml/hr until the postoperative 24 hr (FX2-2-2), or at the decremental rates of 6.0, 4.0, 2.0 ml/hr (D6-4-2) and 8.0, 4.0, 2.0 ml/hr (D8-4-2). The visual analogue score (VAS), incidence of inadequate analgesia, frequency of PCA intervention, and side effects were evaluated.
RESULTS
VAS was significantly higher in FX2-2-2 than in D6-4-2 and D8-4-2 until postoperative 3 hr (P < 0.05). After postoperative 4 hr, VAS was significantly higher in FX2-2-2 than D8-4-2 (P < 0.05). The incidence of inadequate analgesia of FX2-2-2 was significantly greater than D6-4-2 (P = 0.038) and D8-4-2 (P < 0.001) until postoperative 1 hr. None of the patients had ventilatory depression, and postoperative nausea and vomiting were not significant among the groups.
CONCLUSIONS
The time-scheduled decremental background infusion regimens of fentanyl, based on the pharmacokinetic model, could provide more effective postoperative pain management after TIVA, and the side effects and the risk for morbidity were not different from the fixed-rate infusion regimen.

Keyword

Fentanyl; Intravenous anesthesia; Patient-controlled analgesia

MeSH Terms

Analgesia
Analgesia, Patient-Controlled*
Anesthesia, Intravenous*
Fentanyl*
Humans
Hysterectomy
Incidence
Pain, Postoperative
Passive Cutaneous Anaphylaxis
Postoperative Nausea and Vomiting
Respiratory Insufficiency
Fentanyl