ABSTRACT
Fifteen patients undergoing total hip and total knee replacement were studied prospectively to evaluate postoperative pain relief provided by an epidural infusion of fentanyl citrate, with and without lidocaine hydrochloride, and changes in arterial flow to the lower extremities. The patients were randomly placed in three groups: group 1 received epidural fentanyl, 5 micrograms/mL; group 2 received epidural fentanyl, 5 micrograms/mL with 0.75% solution of lidocaine; and group 3 received epidural fentanyl, 5 micrograms/mL with 1.0% solution of lidocaine. All patients received 1.5% solution of epidural etidocaine hydrochloride with epinephrine 1:200,000 for intraoperative anesthesia. No clinical evidence of deep vein thrombosis, tachyphylactic reaction to lidocaine, orthostatic hypotension, or motor block was demonstrated in any patient. The addition of lidocaine to the epidural fentanyl infusion did not improve pain relief or allow a decrease in the rate of infusion. Patients in all groups had improved arterial flow to the lower extremities 24 hours postoperatively.
Subject(s)
Fentanyl/therapeutic use , Joint Prosthesis , Lidocaine/therapeutic use , Pain, Postoperative/drug therapy , Adult , Aged , Aged, 80 and over , Analgesia, Epidural , Drug Therapy, Combination , Female , Fentanyl/administration & dosage , Humans , Leg/blood supply , Lidocaine/administration & dosage , Male , Middle Aged , Prospective Studies , Thrombophlebitis/prevention & controlABSTRACT
A retrospective analysis of 133 patients who received continuous epidural fentanyl for postoperative analgesia is presented. Using a concentration of 5 micrograms/mL of fentanyl, patients received continuous epidural infusions for 24 to 72 hours postoperatively. The average rate of infusion was 60 micrograms/h. A total of 59.3% of the patients received no additional narcotics; 26.3% required supplemental narcotics during the first 24 hours only. Three percent had the infusion discontinued because it provided poor pain control. Side effects were less than, or comparable to, those of epidural morphine. Respiratory depression, defined as a respiratory rate of less than 8, or apnea did not occur. Urinary retention occurred in one patient. Pruritus occurred in 4% (6 patients). Nausea occurred in 25.5%, a rate comparable to that which occurred with epidural morphine. No side effects occurred in 70.6% of the patients reviewed. These data show that epidural fentanyl provides good to excellent pain relief with minimal side effects.
