Comparative evaluation of epidural versus intravenous fentanyl for post–operative analgesia following lower limb surgeries.

Ankit Singh; Deepesh Gupta

Volume : IX, Issue : VIII, August - 2019

Comparative evaluation of epidural versus intravenous fentanyl for post–operative analgesia following lower limb surgeries.

Ankit Singh, Deepesh Gupta

Abstract :

Background: Epidural opioid supplementation has been commonly researched with well proven efficacy for postoperative analgesia however; epidural analgesia comes with its own demerits for which an alternative method for analgesia needs to be searched for. Some studies have suggested that intravenous opioids have advantage of achieving analgesia of comparable efficacy as that of epidural opioids. Hence this study is undertaken to compare the efficacy of epidural versus intravenous opioid and establish superiority of one over the other. Material and Method: With approval of institutional ethics committee and written informed consent, a prospective, randomised study is undertaken on 40 patients from 16 to 60 years of age belonging to ASA physical status I and II, posted for elective lower limb surgery. These patients are randomly divided into two equal groups of 20 each. The patients are given standard anaesthesia using combined spinal epidural approach and cases are conducted under subarachnoid block. During postoperative period, when patient complain of pain, group A (n=20) patients receive 100 mcg fentanyl via epidural route + 10ml of normal saline IV while group B (n=20) patients receive 100 mcg of fentanyl IV + 10ml of NS via epidural route. Pain intensity (using VAS), Hemodynamic parameters (HR, MAP, SBP and DBP) and side effects were taken at 30, 60, 90, 120,150,180,210 and 240 mins and observations were compared between the two groups using appropriate statistical tests. Results: VAS score between two groups was not significantly different till 120 min after fentanyl supplementation. However, after 120 mins patient who received epidural fentanyl did better on VAS score than those who received intravenous fentanyl. Also VAS score at 240 min in group A was 2.54±0.24 where as in group B was 3.25±0.35 which was statistically significant ( P<0.05 ). Thus epidural fentanyl provided better analgesia at 240 min. Patients receiving epidural fentanyl showed more stable HR and MAP during follow–up after 120 mins. The incidence of pruritis and urinary retention was more in patients receiving epidural fentanyl while incidence of nausea, vomiting and respiratory depression was more in group B, who received intravenous fentanyl. The percentage of patient who required supplementary analgesia with diclofenac was lower in group A than in group B. Conclusion: Intravenous fentanyl provides equally efficacious analgesia as compared to epidural but only for shorter duration while epidural fentanyl provides longer duration of postoperative analgesia due to its action at both spinal and supraspinal level via absorption in systemic circulation through epidural space and hence provides hemodynamic stability for longer duration than intravenous fentanyl.