Comparison of the effects of intrathecal fentanyl and intrathecal morphine on postoperative pain for inguinal hernia repair

Year 2018, Volume: 43 Issue: 4, 835 - 839, 29.12.2018

Refika Kılıçkaya Tuna Şahin , Ersel Güleç , Mehtap Balcı Fatih Balcı

https://doi.org/10.17826/cumj.358546

Cited By: 1

Abstract

Purpose: The aim of this study was to compare the effects of intrathecal fentanyl and intrathecal morphine combined with spinal anesthesia on postoperative pain control for inguinal hernia repair.

Materials and Methods: Fifty patients aged 18-60 years with American Society of Anesthesiologists physical status I-II scheduled for elective inguinal hernia repair surgery were enrolled in this prospective randomized double-blinded study. Patients received spinal anesthesia with either 25 mcg fentanyl plus 12.5 mg heavy bupivacaine intrathecally (group F, n=25) or 0.1 mg morphine plus 12.5 mg heavy bupivacaine intrathecally (group M, n=25).Hemodynamic parameters, time to first analgesic requirement, postoperative pain scores, the number of analgesic requirements and side effects over postoperative 24 h were recorded.

Results: Pain scores were significantly lower in group M compared with group F in the postoperative 24 h. The time to first analgesic requirement was higher in group M than group F. Analgesic requirement was higher in group F than group M for postoperative 24 h. 

Conclusion: We concluded that the addition of 0.1 mg morphine intrathecally to 12.5 mg heavy bupivacaine provides improved postoperative analgesia, especially after postoperative 12 h than 25 mcg fentanyl for inguinal hernia repair under spinal anesthesia.

Keywords

spinal anesthesia; morphine; fentanyl; postoperative analgesia

İnguinal herni tamiri sonrası postoperatif ağrı üzerinde intratekal fentanil ve intratekal morfinin etkilerinin karşılaştırılması

Abstract

Amaç: Çalışmamızın amacı inguinal herni onarımı geçiren hastalarda intratekal fentanil ve intratekal morfin ile uygulanan spinal anestezinin postoperatif ağrı etkilerini karşılaştırmaktır.

Gereç ve Yöntem: Elektif inguinal herni onarımı geçirecek olan 18-60 yaşları arasında, Amerikan Anesteziyologları Derneği fizik durum I-II’ye sahip olan 50 hasta, prospektif, randomize çift kör çalışmamıza dahil edildi. Hastalara 12.5 mg heavy bupivakaine ilave olarak bir grupta 25 mcg fentanil (grup F, n=25) ve diğer grupta 0,1 mg morfin (grup M, n= 25) intratekal yolla uygulandı. Hemodinamik ölçümler, postoperatif ilk analjezik gereksinimi için geçen süre, postoperatif ağrı skorları, analjezik gereksinim sayısı ve yan etkiler 24 saat içinde kaydedildi.

Bulgular: Postoperatif 24 saatte ağrı skorları, grup F ile karşılaştırıldığında grup M’de belirgin olarak düşüktü. Postoperatif ilk analjezik gereksinim için geçen süre, grup M’de grup F’ye göre belirgin yüksekti.  Postoperatif 24 saat için kümülatif analjezik gereksinim sayısı grup F’de grup M’e göre belirgin yüksekti. 

Sonuç: İnguinal herni tamiri geçirecek hastalarda spinal anestezi amacıyla intratekal 12,5 mg heavy bupivakaine 0,1 mg morfin eklenmesi, 25 mcg fentanil eklenmesine göre özellikle postoperatif 12 saat sonra daha etkili analjezi oluşturmuştur.

Keywords

Spinal anestezi, morfin, fentanil, postoperatif ağrı

References

• 1. Schumpelick V, Treutner KH, Arlt G. Inguinal hernia repair in adults. Lancet. 1994;344:375-379. 2. Meco BC, Bermede O, Vural C, et al. A comparison of two different doses of morphine added to spinal bupivacaine for inguinal hernia repair. Braz J Anesthesiol. 2016;66:140-144. 3. Kallio H, Snall EV, Suvanto SJ, et al. Spinal hyperbaric ropivacaine-fentanyl for day-surgery. Reg Anesth Pain Med. 2005;30:48-54. 4. Pere P, Harju J, Kairaluoma P, et al. Randomized comparison of the feasibility of three anesthetic techniques for day-case open inguinal hernia repair. J Clin Anesth. 2016;34:166-175. 5. Seewal R, Shende D, Kashyap L, et al. Effect of addition of various doses of fentanyl intrathecally to 0.5% hyperbaric bupivacaine on perioperative analgesia and subarachnoid-block characteristics in lower abdominal surgery: A dose-response study. Reg Anesth Pain Med. 2007;32:20-26. 6. Popping DM, Elia N, Marret E, et al. Opioids added to local anesthetics for single-shot intrathecal anesthesia in patients undergoing minor surgery: a meta-analysis of randomized trials. Pain. 2012;153:784-793. 7. Cousins MJ, Mather LE. Intrathecal and epidural administration of opioids. Anesthesiology. 1984;61:276-310. 8. Ummenhofer WC, Arends RH, Shen DD, et al. Comparative spinal distribution and clearance kinetics of intrathecally administered morphine, fentanyl, alfentanil, and sufentanil. Anesthesiology. 2000;92:739-753. 9. Girgin NK, Gurbet A, Turker G, et al. The combination of low-dose levobupivacaine and fentanyl for spinal anaesthesia in ambulatory inguinal herniorrhaphy. J Int Med Res. 2008;36:1287-1292. 10. Gupta A, Axelsson K, Thorn SE, 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;47:13-19. 11. Siti Salmah G, Choy YC. Comparison of morphine with fentanyl added to intrathecal 0.5% hyperbaric bupivacaine for analgesia after caesarean section. Med J Malaysia. 2009;64:71-74. 12. Karaman S, Gunusen I, Uyar M, et al. The effects of morphine and fentanyl alone or in combination added to intrathecal bupivacaine in spinal anesthesia for cesarean section. Agri : Agri. 2011;23:57-63. 13. Agrawal A, Asthana V, Sharma JP, et al. Efficacy of lipophilic vs lipophobic opioids in addition to hyperbaric bupivacaine for patients undergoing lower segment caeserean section. Anesth Essays Res. 2016;10:420-424. 14. Saracoglu A, Saracoglu KT, Eti Z. Comparative study of fentanyl and morphine in addition to hyperbaric or isobaric bupivacaine in combined spinal anaesthesia for caesarean section. Arch Med Sci. 2011;7:694-699. 15. Sibilla C, Albertazz P, Zatelli R, et al. Perioperative analgesia for caesarean section: comparison of intrathecal morphine and fentanyl alone or in combination. Int J Obstet Anesth. 1997;6:43-48. 16. Bailey PL, Rhondeau S, Schafer PG, et al. Dose-response pharmacology of intrathecal morphine in human volunteers. Anesthesiology. 1993;79:49-59; discussion 25A. 17. Bailey PL, Lu JK, Pace NL, et al. Effects of intrathecal morphine on the ventilatory response to hypoxia. N Engl J Med. 2000;343:1228-1234.