TY - JOUR
T1 - Lumbar epidural fentanyl infusions for post-thoracotomy patients
T2 - Analgesic, respiratory, and pharmacokinetic effects
AU - Badner, N. H.
AU - Sandler, A. N.
AU - Koren, G.
AU - Lawson, S. L.
AU - Klein, J.
AU - Einarson, T. R.
N1 - Funding Information:
From the Department of Anesthesia, Toronto General Hospital; the Department of Clinical Pharmacology. Hospital for Sick Children; and the Faculty of Pharmacy, University of Toronto, Ontario, Canada. Supported in part by a grant from Janssen Pharma-ceutica, Inc. Mississauga, Ontario. Presented at the Annual Meeting of the American of Anesthesiologists, New Orleans, LA, October
PY - 1990/10
Y1 - 1990/10
N2 - Ten patients undergoing a thoracotomy were studied for 24 hours postoperatively to determine the effects of a continuous lumbar epidural fentanyl infusion on postoperative pain, arterial blood gases (ABG), respiratory pattern (respiratory inductive plethysmography, RIP), and fentanyl plasma concentration (CONC). Patients served as their own controls because RIP and ABG data were obtained the night prior to surgery during sleep. Epidural fentanyl was administered as a bolus of 1.5 μg/kg followed by an infusion of 1.0 μg/kg/h started 1 hour after induction. Insufficient analgesia was treated with a bolus of 0.5 μg/kg and an infusion increase of 0.25 μg/kg/h. Postoperative assessment included RIP, ABG, CONC, and visual analog pain score (PS). The average infusion rate postoperatively was 1.47 ± 0.08 μg/kg/h (114.3 ± 8.3 μg/h). A mean PS of 2.1 ± 0.3 was achieved; however, there was a delay in attaining this. There was no significant incidence postoperatively of apnea or slow respiratory rate. A significant byt clinically insubstantial increase in PaCO2 and decrease in pH occurred. A steady state CONC of approximately 2.0 ng/mL was reached after 9 hours. The PS correlated with CONC in half the patients (0.60 < r < 0.86), indicating a systemic component may have contributed to the analgesic effect.
AB - Ten patients undergoing a thoracotomy were studied for 24 hours postoperatively to determine the effects of a continuous lumbar epidural fentanyl infusion on postoperative pain, arterial blood gases (ABG), respiratory pattern (respiratory inductive plethysmography, RIP), and fentanyl plasma concentration (CONC). Patients served as their own controls because RIP and ABG data were obtained the night prior to surgery during sleep. Epidural fentanyl was administered as a bolus of 1.5 μg/kg followed by an infusion of 1.0 μg/kg/h started 1 hour after induction. Insufficient analgesia was treated with a bolus of 0.5 μg/kg and an infusion increase of 0.25 μg/kg/h. Postoperative assessment included RIP, ABG, CONC, and visual analog pain score (PS). The average infusion rate postoperatively was 1.47 ± 0.08 μg/kg/h (114.3 ± 8.3 μg/h). A mean PS of 2.1 ± 0.3 was achieved; however, there was a delay in attaining this. There was no significant incidence postoperatively of apnea or slow respiratory rate. A significant byt clinically insubstantial increase in PaCO2 and decrease in pH occurred. A steady state CONC of approximately 2.0 ng/mL was reached after 9 hours. The PS correlated with CONC in half the patients (0.60 < r < 0.86), indicating a systemic component may have contributed to the analgesic effect.
UR - https://www.scopus.com/pages/publications/0025152283
U2 - 10.1016/0888-6296(90)90402-2
DO - 10.1016/0888-6296(90)90402-2
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C2 - 2132132
AN - SCOPUS:0025152283
SN - 0888-6296
VL - 4
SP - 543
EP - 551
JO - Journal of Cardiothoracic Anesthesia
JF - Journal of Cardiothoracic Anesthesia
IS - 5
ER -