ABSTRACT
Thoracic epidural fentanyl has been used successfully for postoperative analgesia in patients undergoing thoracic surgery. Prior investigators have suggested that increasing the administered dosage and volume of lumbar epidural fentanyl may increase the spread of analgesia. The feasibility of injecting a high volume (20 mL) of fentanyl into the lumbar epidural space for post-thoracic surgery analgesia was studied in 17 patients undergoing elective thoracotomy or sternotomy. All patients had a lumbar epidural catheter placed before induction of general anesthesia. No narcotic was administered during surgery. Thirty minutes before the conclusion of anesthesia, 200 micrograms of fentanyl in 16 mL of 0.9% saline was administered via the epidural route. In the intensive care unit (ICU), additional fentanyl in the same dosage and volume was injected when the patient complained of pain. Pain was scored on a linear analog scale pre-injection and 30 minutes post-injection. Arterial blood gases were obtained simultaneously. All patients experienced pain relief within 15 minutes of injection. No significant respiratory depression or hypercarbia was noted. Lumbar epidural fentanyl is a safe and practical alternative to thoracic epidural analgesia in the post-thoracic surgical patient.
Subject(s)
Analgesia, Epidural , Fentanyl/therapeutic use , Thoracotomy , Adolescent , Adult , Aged , Anesthesia, Epidural , Carbon Dioxide/blood , Female , Fentanyl/administration & dosage , Humans , Lumbar Vertebrae , Male , Middle Aged , Pain Measurement , Pain, Postoperative/prevention & control , Respiration , Sternum/surgeryABSTRACT
The effects of a single dose of cyclosporine on anesthetic actions of pentobarbital and fentanyl were studied in mice. Mice given pentobarbital 2 hr after receiving cyclosporine, 60 mg/kg, slept a statistically significant 2.3 times longer than did controls. In a second study, each of two dose levels of cyclosporine was given before each of four dose levels of fentanyl. The analgesic effect of fentanyl, measured with the abdominal constriction test, was dose-dependent. Cyclosporine significantly increased the analgesia produced by fentanyl and did so in a dose-dependent manner. Cyclosporine by itself did not produce analgesia. Plasma levels of fentanyl and binding of fentanyl by plasma proteins were unchanged by cyclosporine treatment. The results show that a single dose of cyclosporine can increase pentobarbital hypnosis and fentanyl analgesia in mice but do not establish the mechanism of these interactions.
