Effect of nebulized versus intravenous fentanyl for postoperative analgesia after unilateral femur interlock surgery

Jaideep Singh; D Premkumar; Aditya Agarwal

doi:10.4103/BJOA.BJOA_14_20

ORIGINAL ARTICLE

Year : 2020 | Volume : 4 | Issue : 2 | Page : 59-61

Effect of nebulized versus intravenous fentanyl for postoperative analgesia after unilateral femur interlock surgery

Jaideep Singh, D Premkumar, Aditya Agarwal
Department of Anesthesia, Gandhi Medical College, Bhopal, Madhya Pradesh, India

Date of Submission	26-Feb-2020
Date of Decision	09-Mar-2020
Date of Acceptance	18-Mar-2020
Date of Web Publication	11-May-2020

Correspondence Address:
Dr. D Premkumar
No. 59, Kidwai Road, Shahjahanabad, Bhopal - 462 001, Madhya Pradesh
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/BJOA.BJOA_14_20

Abstract

Background: This study was aimed to compare the effect of nebulized fentanyl versus intravenous fentanyl for postoperative analgesia after unilateral femur interlock surgery. Patients and Methods: A total of sixty patients scheduled for unilateral femur interlock surgery under subarachnoid block were enrolled in the study and were randomly divided into two groups. Group I included thirty patients who received 2 μg/kg of fentanyl intravenously, and Group N included thirty patients who received 4 μg/kg of fentanyl nebulization using a standard venturi mask. In the postoperative period, whenever the Visual Analog Scale ≥4, patients received the analgesic corresponding to their respective groups. The data obtained were statistically analyzed using IBM SPSS software. Results: There was no significant difference in the demographic characteristics, duration of surgery, the number of patients who required rescue analgesia, and the onset of analgesia in Group N in comparison with Group I. The duration of analgesia was significantly longer in Group N in comparison to Group I. In Group I, the rise in Ramsay sedation score was faster and peaked at 5 min. In Group N, however, it was lesser than that of Group I. Side effects in Group N were significantly lesser compared to Group I. Conclusion: Nebulization with fentanyl is a good alternative to intravenous fentanyl for adequate postoperative pain relief with fewer side effects.

Keywords: Analgesia, femur interlock surgery, fentanyl, nebulized, postoperative

How to cite this article:
Singh J, Premkumar D, Agarwal A. Effect of nebulized versus intravenous fentanyl for postoperative analgesia after unilateral femur interlock surgery. Bali J Anaesthesiol 2020;4:59-61

How to cite this URL:
Singh J, Premkumar D, Agarwal A. Effect of nebulized versus intravenous fentanyl for postoperative analgesia after unilateral femur interlock surgery. Bali J Anaesthesiol [serial online] 2020 [cited 2023 Mar 23];4:59-61. Available from: https://www.bjoaonline.com/text.asp?2020/4/2/59/284174

Introduction

Intravenous route for fentanyl administration has been the most preferred route of administration for anesthesia and analgesia for surgical procedures and intensive care unit sedation.^[1] However, it is associated with several side effects such as nausea, vomiting, sedation, hypotension, bradycardia, pruritis, and respiratory depression.^[2]

Fentanyl is a highly lipophilic drug that can be administered through several routes such as subcutaneous, transdermal, sublingual, and nasal spray. One of the rarely used routes of fentanyl administration is inhalational drug delivery.^[3] This study was aimed to compare the effect of nebulized fentanyl versus intravenous fentanyl for postoperative analgesia after unilateral femur interlock surgery.

Patients and Methods

This prospective double-blinded randomized comparative clinical study was conducted from January 2019 to January 2020. After obtaining institutional ethical committee clearance and informed consent, sixty patients of 20–50 years old with the American society of anesthesiologists (ASA) Grade I and II posted for elective unilateral femur interlock surgery under subarachnoid block were enrolled for the study. The sixty patients were divided into two equal groups of thirty patients each by sealed envelope method.

Exclusion criteria include those who refused to take part in the study, patients with renal, cardiac, and hepatic impairment and bleeding diathesis, pregnant and breastfeeding women, patients with hypersensitivity to opioids, patients taking drugs that have interactions with fentanyl, patients with body mass index >30 kg/m^[2], patients with neuropsychiatric disorders, and patients who were receiving sedatives or any other narcotic drugs.

The sixty patients were randomly divided into two groups of thirty patients each by sealed envelope method. Group I included thirty patients who received 2 μg/kg of fentanyl diluted in 10 ml of normal saline with 5 ml of normal saline nebulized using a nebulizer through standard venturi mask at 8–10 L/min flow of oxygen for 10 min. Group N included thirty patients who received 10 ml of normal saline with 4 μg/kg of fentanyl in 5 ml of normal saline, nebulized using a nebulizer through standard venturi mask at 8–10 L/min flow of oxygen for 10 min.

In the operation theater, all patients received standard premedication with ondansetron 0.15 mg/kg and ranitidine 150 mg. The subarachnoid block was carried out with 17.5 mg bupivacaine (heavy) through a 25G spinal needle. The target block level was kept between T8 and T10. Standard ASA monitoring was applied. Patients were kept in the postanesthesia care unit for 24 h after the end of surgery for observation. The intensity of postoperative pain was recorded for all patients using the Visual Analog Scale (VAS) after surgery. Both the groups received the analgesic drug by a blinded observer through either intravenous or nebulization routes.

The following parameters were recorded: duration of surgery (time from skin incision to the removal of drapes), the onset of analgesia (time from the admission of the analgesic until the VAS score becomes ≤2), duration of analgesia (time from the onset of analgesia until the VAS score becomes greater ≥ 4), level of sedation using Ramsay sedation scale (every 5 min up to 30 min and then at intervals of 15 min up to 2 h), number of patients with inadequate analgesia, and signs of opioid side effects.

The sample size was estimated based on a pilot study. The data obtained were statistically analyzed using IBM SPSS software (IBM Corp. Released 2017. IBM SPSS Statistics for Windows, version 25.0. Armonk, NY: IBM Corp.). Qualitative data were analyzed using the Chi-square test and Z-test. Quantitative data were analyzed using the Student's t-test. P < 0.05 was considered statistically significant.

Results

There was no significant difference in the demographic characteristics, duration of surgery, and the number of patients who required rescue analgesia, as displayed in [Table 1]. There was no significant delay in the onset of analgesia in Group N in comparison with Group I, and also, the duration of analgesia was significantly longer in Group N in comparison to Group I.

Table 1: Demographic characteristics, duration of surgery, and onset and duration of analgesia

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In Group I, the rise in Ramsay sedation [Table 2] score was faster and peaked at 5 min. Side effects in Group N were significantly lesser compared to Group I [Table 3].

Table 2: Ramsay sedation score

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Table 3: Side effect comparison

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Discussion

This study of comparison of the effect of nebulized fentanyl (4 mg/kg) versus intravenous fentanyl (2 mg/kg) was based on a study conducted by Abd El-Hamid et al.,^[3] the result of which was that nebulized fentanyl produced more extended analgesia than intravenous fentanyl with fewer side effects.

Furthermore, previously, Farahmand et al. had compared the effectiveness of nebulized fentanyl with intravenous morphine in the management of acute limb pain and proposed that nebulized fentanyl is a rapid, safe, and effective method for temporary control of acute limb pain in emergency department patients.^[4],[5],[6]

Furyk et al. also compared the efficacy of nebulized fentanyl with intravenous morphine in pediatric patients presenting to the emergency department with clinically suspected limb fractures and found that nebulized fentanyl at a dose of 4 μg/kg provided a clinically significant improvement in pain scores, comparable to that of intravenous morphine.^[7] Several studies have documented the effectiveness of nebulized fentanyl compared with intravenous fentanyl.^{[2],[3],[6],[7],[8],[9],[10],[11],[12],[13]}

In this study, we found that there was no significant delay in the onset of analgesia in Group N in comparison with Group I. In contrast, the duration of analgesia was significantly longer in Group N in comparison with Group I. This was in contrary to the study conducted by Abd El-Hamid et al.^[3] Several studies reported that nebulization with fentanyl had fewer side effects.^{[2],[3],[4],[6],[8]} The limitation of the study was that serum fentanyl levels were not taken into account.

Conclusion

Nebulization with fentanyl is a good alternative to intravenous fentanyl for adequate postoperative pain relief with fewer side effects.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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