|
January 1997
Recovery After Propofol With and Without Intraoperative Fentanyl in Patients Undergoing Ambulatory Gynecologic Laparoscopy
Sukhani R, Vazquez J, Pappas AL, Frey K, Aasen M, Slogoff S;
Anesthesia and Analgesia 1996;83:975-81
[ see abstract below ]
This study evaluates the effect of intraoperative fentanyl supplementation on postoperative indices for ambulatory surgery patients.
Patients underwent ambulatory gynecologic laparoscopy and received either fentanyl 100 mcg or ketorolac 60 mg IV at the time of anesthetic induction, with a propofol-nitrous oxide-atracurium anesthesia. Duration of anesthesia was 82-87 minutes. Maintenance dose of propofol was lower in the fentanyl
group, but emergence times in the two groups were comparable.
Postoperative analgesics were required during early recovery by 84% of
patients receiving fentanyl and 56% of patients receiving ketorolac.
However, the analgesia provided by ketorolac was by itself not sufficient
for postoperative pain management, since 56% of those patients did require
a rescue analgesic.
Emetic sequelae in the PACU occurred in 42% of
fentanyl patients and 23% of ketorolac patients (not significantly
different) but the fentanyl patients did require significantly more rescue
antiemetics, 29% vs. 10%. Emetic sequelae 24 hours at home after discharge
were comparable, but the overall emetic sequelae from awakening to 24 hours
was higher in the fentanyl group, 52% vs. 28%.
Times to ambulation and
discharge were significantly longer in the fentanyl group. The results of
this study recommend against giving fentanyl 100 mcg at anesthetic
induction since it fails to provide effective postoperative analgesia,
increases the need for rescue antiemetics and prolongs discharge.
Return to the Current Literature Review Front Page, or read the abstract:
ABSTRACT
This prospective, randomized double-blind study was conducted to examine the effect of intraoperative opiod (fentanyl) supplementation on postoperative analgesia, emesis, and recovery in ambulatory patients receiving propofol-nitrous oxide anesthesia. Eighty patients undergoing ambulatory gynecologic laparoscopy participated.
Confounding variables that could influence the incidence of postoperative emesis were controlled. Patients received either fentanyl 100ug (Group I) or ketorolac 60 mg (Group II) intravenously (IV) at the time of anesthetic induction. No further analgesic supplements were given intraoperatively. Anesthesia was induced and propofol and maintained with propofol-nitrous oxide. Atracurium was used for muscle relaxation and reversed with neostigimine and glycopyrrolatc.
Postoperative pain during early recovery was treated with IV fentanyl 25-50 ug (Group I) or IV ketorolac 15-30 mg (Group II). Subsequent breakthrough pain in both groups was treated with IV fentanyl 25ug increments as needed (rescue analgesia). Eighty-four percent of patients in Group I required analgesics during early recovery versus 56% of patients in group II (P < 0.05).
Maintenance dose of propofol was significantly lower in Group I (129 + 35 ug - kg -1 - min -1) than in Group II (170 + 63 ug - kg -1 - min -1). Immediate recovery (emergence) in the two groups was comparable, despite different propofol requirements. Although the incidence of emetic sequelae in the postanesthesia care unit was not significantly different between the two treatment groups, a significantly larger number of patients in Group I (fentanyl group) had emetic sequelae that required therapeutic intervention (Group I 29% versus Group II 10%).
Patients in Group I also took a significantly longer time to ambulate and meet criteria for home discharge. These results indicate that, in patients undergoing ambulatory gynecologic laparoscopy, the practice of administering a small dose of fentanyl at the time of anesthetic induction reduces maintenance propofol requirement, but fails to provide effective postoperative analgesia. Fentanyl administration at anesthetic induction increased the need for rescue antiemetics. The relative severity of emetic sequelae could have contributed to delay in ambulation and discharge.
|
