Adverse side effects of fentanyl plus bupivacaine subarachnoid anesthesia
Fentanyl: efectos adversos en anestesia subaracnoidea con bupivacaína
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Reyes, L. E., Robayo, M., Preciado Aponte, C. A., Pulido, J. A., Navarro Castro, J. A., & Ríos Gamboa, G. (2010). Adverse side effects of fentanyl plus bupivacaine subarachnoid anesthesia. Journal of Medicine and Surgery Repertoire, 19(3), 201–207. https://doi.org/10.31260/RepertMedCir.v19.n3.2010.608
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Abstract
Adverse effects of opioids result of their interactions with opioid brain receptors. Intrathecal administration of fentanyl may induce respiratory depression but less frequently than when intravenously administered. Objegtive: to describe the frequency of adverse side effects in surgical patients at Hospital de San José who received intrathecal fentanyl plus hyperbaric bupivacaine. Materials and Methods: descriptive study of a cohort of patients who underwent surgery at Hospital de San José between October 1 2007 and September 30 2009, who received intratecal fentanyl plus hyperbaric bupivacaine. Patients aged 18 to a5 years, nonpregnant women and those who were not converted into general anesthesia were included. Results: 313 patients were studied, 39.9% women with mean age 42 years (SD: 12.7), classified as: ASA I a0.7%; ASA II, 33.3%; ASA III, 5.7% and ASA IV, 0.3%. The most common adverse side effects were, nausea 8.a% (n: 27), pruritus a.7% (n: 21), vomiting 2.2% (n: 7) and bradycardia 2.2% (n: 7). Respiratory depression presented in 1.3% (n: 4). Conglusions: our report of the frequency of respiratory depression is within that described in literature; however, it must be considered that the measuring methods were not consistent. Other adverse events were lower than those reported.
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References
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3. HerpolsheimerA, Schretenthaler J. The use of intrapartum intrathecal narcotic analgesia in a community-based hospital. Obstet Gynecol. 1994 Dec; 84(6):931-6.
4. Techanivate A, Urusopone P, Hiatgungwanglia P, Hosawiboonpol R. Intrathecal fentanyl in spinal anesthesia for appendectomy. J Med Assoc Thai 2004 May;87(5):525-30.
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6. Brown, David L. Spinal, Epidural, and Caudal anesthesia. In: Miller R, editor. Miller's anesthesia. 7a ed. Philadelphia : Elsevier Churchill Livingstone, 2009.
7. Heats AS. The ASA classification of physical status—a recapitulation. Anesthesiology. 1978 Oct; 49(4): 233-6.
8. Grundy SM, Cleeman JI, Merz CN, Brewer HB, Jr., Clark LT, Hunninghake DB, et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation. 2004 Jul 13; 110(2): 227-39.
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10. American Heart Association. ECC Committee, Subcommittees and Task Forces. 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2005 Dec 13;112(24 Suppl):IV1-203.
11. Reuben SS, Dunn SM, Duprat HM, O’Sullivan P. An intrathecal fentanyl dose-response study in lower extremity revascularization procedures. Anesthesiology. 1994 Dec;81(6):1371-5.
12. Vaughan DJ, Ahmad N, Lillywhite NH, Lewis N, Thomas D, Robinson PN. Choice of opioid for initiation of combined spinal epidural analgesia in labour—fentanyl or diamorphine. Br J Anaesth. 2001 Apr;86(4):567-9.
13. Urwin SC, Parker MJ, Griffiths R. General versus regional anaesthesia for hip fracture surgery: a meta-analysis of randomized trials. Br J Anaesth. 2000 Apr; 84(4):450-5.
14. Ben-David B, Frankel R, Arzumonov T, Marchevsky Y, Volpin G. Minidose bupivacaine-fentanyl spinal anesthesia for surgical repair of hip fracture in the aged. Anesthesiology. 2000 Jan; 92(1):6-10.
15. Fernandez-Galinski D, Rue M, Moral V, Castells C, Puig MM. Spinal anesthesia with bupivacaine and fentanyl in geriatric patients. Anesth Analg. 1996 Sep;83(3):537-41.
16. Fournier R, Van GE, Weber A, Gamulin X. A comparison of intrathecal analgesia with fentanyl or sufentanil after total hip replacement. Anesth Analg. 2000 Apr;90(4):918-22.
17. Gupta A, Axelsson H, Thorn SE, Matthiessen P, Larsson LG, Holmstrom B, et al. Low-dose bupivacaine plus fentanyl for spinal anesthesia during ambulatory inguinal herniorrhaphy: a comparison between 6 mg and 7. 5 mg of bupivacaine. Acta Anaesthesiol Scand. 2003 Jan;47(1):13-9.
18. Ginosar Y, Mirikatani E, Drover DR, Cohen SE, Riley ET. ED50 and ED95 of intrathecal hyperbaric bupivacaine coadministered with opioids for cesarean delivery. Anesthesiology. 2004 Mar;100(3):676-82.
19. Horhonen AM, Valanne JV, Jokela RM, Ravaska P, Horttila H. Intrathecal hyperbaric bupivacaine 3 mg + fentanyl 10 microg for outpatient knee arthroscopy with tourniquet. Acta Anaesthesiol Scand. 2003 Mar;47(3):342-6.
20. Stamenkovic D, Geric V, Djordjevic M, Raskovic J, Slavkovic X, Randjelovic T, et al. Subarachnoid morphine, bupivacaine and fentanyl as part of combined spinal-epidural analgesia for low anterior resection.Aprospective, randomised, double-blind clinical trial. Anaesth Intensive Care. 2009 Jul;37(4):552-60.
21. Sudarshan G, Browne BL, Matthews JN, Conacher ID. Intrathecal fentanyl for post-thoracotomy pain. Br J Anaesth. 1995 Jul;75(1):19-22.
22. Ummenhofer WC, Arends RH, Shen DD, Bernards CM. Comparative spinal distribution and clearance kinetics of intrathecally administered morphine, fentanyl, alfentanil, and sufentanil. Anesthesiology. 2000 Mar;92(3):739-53.
23. Hamber EA, Viscomi CM. Intrathecal lipophilic opioids as adjuncts to surgical spinal anesthesia. Reg Anesth Pain Med. 1999 May;24(3):255-63.
24. Bernards CM. Recent insights into the pharmacokinetics of spinal opioids and the relevance to opioid selection. Curr Opin Anaesthesiol. 2004 Oct; 17(5):441-7.
25. Wells J, Paech MJ, Evans SF. Intrathecal fentanyl-induced pruritus during labour: the effect of prophylactic ondansetron. Int J Obstet Anesth. 2004 Jan;13(1):35-9.
26. Hhan FA, Hamdani GA. Comparison of intrathecal fentanyl and buprenorphine in urological surgery. J Pak Med Assoc. 2006 Jun;56(6):277-81.
27. Jain H, Grover VH, Mahajan R, Batra YH. Effect of varying doses of fentanyl with low dose spinal bupivacaine for caesarean delivery in patients with pregnancy-induced hypertension. Int J Obstet Anesth. 2004 Oct;13(4):215-20.
2. Gwirtz HH, Young JV, Byers RS, Alley C, Levin H, Walker SG, et al. The safety and efficacy of intrathecal opioid analgesia for acute postoperative pain: seven years’ experience with 5969 surgical patients at Indiana University Hospital. Anesth Analg. 1999 Mar; 88(3):599-604.
3. HerpolsheimerA, Schretenthaler J. The use of intrapartum intrathecal narcotic analgesia in a community-based hospital. Obstet Gynecol. 1994 Dec; 84(6):931-6.
4. Techanivate A, Urusopone P, Hiatgungwanglia P, Hosawiboonpol R. Intrathecal fentanyl in spinal anesthesia for appendectomy. J Med Assoc Thai 2004 May;87(5):525-30.
5. Miller R, editor. Miller's anesthesia. 7a ed. Philadelphia : Elsevier Churchill Livingstone, 2009.
6. Brown, David L. Spinal, Epidural, and Caudal anesthesia. In: Miller R, editor. Miller's anesthesia. 7a ed. Philadelphia : Elsevier Churchill Livingstone, 2009.
7. Heats AS. The ASA classification of physical status—a recapitulation. Anesthesiology. 1978 Oct; 49(4): 233-6.
8. Grundy SM, Cleeman JI, Merz CN, Brewer HB, Jr., Clark LT, Hunninghake DB, et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation. 2004 Jul 13; 110(2): 227-39.
9. Obesity, Sleep Apnea, theAirway and Anesthesia. In: Hagber CA. Benumof’s airway management. 2nd ed. Philadelphia : Mosby; 2007.
10. American Heart Association. ECC Committee, Subcommittees and Task Forces. 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2005 Dec 13;112(24 Suppl):IV1-203.
11. Reuben SS, Dunn SM, Duprat HM, O’Sullivan P. An intrathecal fentanyl dose-response study in lower extremity revascularization procedures. Anesthesiology. 1994 Dec;81(6):1371-5.
12. Vaughan DJ, Ahmad N, Lillywhite NH, Lewis N, Thomas D, Robinson PN. Choice of opioid for initiation of combined spinal epidural analgesia in labour—fentanyl or diamorphine. Br J Anaesth. 2001 Apr;86(4):567-9.
13. Urwin SC, Parker MJ, Griffiths R. General versus regional anaesthesia for hip fracture surgery: a meta-analysis of randomized trials. Br J Anaesth. 2000 Apr; 84(4):450-5.
14. Ben-David B, Frankel R, Arzumonov T, Marchevsky Y, Volpin G. Minidose bupivacaine-fentanyl spinal anesthesia for surgical repair of hip fracture in the aged. Anesthesiology. 2000 Jan; 92(1):6-10.
15. Fernandez-Galinski D, Rue M, Moral V, Castells C, Puig MM. Spinal anesthesia with bupivacaine and fentanyl in geriatric patients. Anesth Analg. 1996 Sep;83(3):537-41.
16. Fournier R, Van GE, Weber A, Gamulin X. A comparison of intrathecal analgesia with fentanyl or sufentanil after total hip replacement. Anesth Analg. 2000 Apr;90(4):918-22.
17. Gupta A, Axelsson H, Thorn SE, Matthiessen P, Larsson LG, Holmstrom B, et al. Low-dose bupivacaine plus fentanyl for spinal anesthesia during ambulatory inguinal herniorrhaphy: a comparison between 6 mg and 7. 5 mg of bupivacaine. Acta Anaesthesiol Scand. 2003 Jan;47(1):13-9.
18. Ginosar Y, Mirikatani E, Drover DR, Cohen SE, Riley ET. ED50 and ED95 of intrathecal hyperbaric bupivacaine coadministered with opioids for cesarean delivery. Anesthesiology. 2004 Mar;100(3):676-82.
19. Horhonen AM, Valanne JV, Jokela RM, Ravaska P, Horttila H. Intrathecal hyperbaric bupivacaine 3 mg + fentanyl 10 microg for outpatient knee arthroscopy with tourniquet. Acta Anaesthesiol Scand. 2003 Mar;47(3):342-6.
20. Stamenkovic D, Geric V, Djordjevic M, Raskovic J, Slavkovic X, Randjelovic T, et al. Subarachnoid morphine, bupivacaine and fentanyl as part of combined spinal-epidural analgesia for low anterior resection.Aprospective, randomised, double-blind clinical trial. Anaesth Intensive Care. 2009 Jul;37(4):552-60.
21. Sudarshan G, Browne BL, Matthews JN, Conacher ID. Intrathecal fentanyl for post-thoracotomy pain. Br J Anaesth. 1995 Jul;75(1):19-22.
22. Ummenhofer WC, Arends RH, Shen DD, Bernards CM. Comparative spinal distribution and clearance kinetics of intrathecally administered morphine, fentanyl, alfentanil, and sufentanil. Anesthesiology. 2000 Mar;92(3):739-53.
23. Hamber EA, Viscomi CM. Intrathecal lipophilic opioids as adjuncts to surgical spinal anesthesia. Reg Anesth Pain Med. 1999 May;24(3):255-63.
24. Bernards CM. Recent insights into the pharmacokinetics of spinal opioids and the relevance to opioid selection. Curr Opin Anaesthesiol. 2004 Oct; 17(5):441-7.
25. Wells J, Paech MJ, Evans SF. Intrathecal fentanyl-induced pruritus during labour: the effect of prophylactic ondansetron. Int J Obstet Anesth. 2004 Jan;13(1):35-9.
26. Hhan FA, Hamdani GA. Comparison of intrathecal fentanyl and buprenorphine in urological surgery. J Pak Med Assoc. 2006 Jun;56(6):277-81.
27. Jain H, Grover VH, Mahajan R, Batra YH. Effect of varying doses of fentanyl with low dose spinal bupivacaine for caesarean delivery in patients with pregnancy-induced hypertension. Int J Obstet Anesth. 2004 Oct;13(4):215-20.