Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2020.12.013
Brazilian Journal of Anesthesiology
Clinical Research

Comparison of low dose intravenous fentanyl and morphine infusion for postoperative analgesia in spine fusion surgeries – a randomized control trial

Comparação da infusão intravenosa em baixa dosagem de fentanil e morfina para analgesia pós-operatória em cirurgias de fusão da coluna vertebral - um estudo de controle randomizado

Rajagopalan Venkatraman, Anand Pushparani, Ramamurthy Balaji, Prabhuvel Nandhini

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Abstract

Background and aims
Post-operative analgesia for Spine surgeries is difficult without patient control analgesia (PCA) and inadequate monitoring facilities. The objective was to study the effectiveness of analgesia of intravenous administration of low dose fentanyl and morphine for postoperative analgesia following spine fusion surgeries.

Methods
One hundred adult patients undergoing spine instrumentation surgeries were randomly allotted into two groups: Group M (morphine) or Group F (fentanyl). The patients received either 0.02 mg.kg-1.h-1 of morphine or 0.3 mcg.kg-1.h-1 of fentanyl infusion postoperatively. If the patient had pain, additional bolus dose of 0.04 mg.kg-1 and 0.6 mcg. kg-1 bolus for morphine and fentanyl respectively were given and noted. The additional analgesic consumption was recorded. The Ramsay sedation score (RSS), visual analogue score (VAS), vital parameters and complications were observed.

Results
The demographic characteristics did not reveal significant difference among the two groups. In morphine group, 32 patients did not require any additional bolus dose, 15 patients needed one bolus dose and one patient each required two and three boluses. In fentanyl group, two, 24, 20 and four patients required 0, 1, 2 and 3 bolus doses respectively. There were no statistically significant variations in hemodynamic features like heart rate, blood pressure and oxygen saturation, RSS and VAS. The complication rate was not significant among the groups.

Conclusion
Low dose continuous infusion of morphine is more effective than fentanyl with fewer requirements of rescue analgesics for postoperative analgesia. Both drugs are safe without any serious complications.

Keywords

Fentanyl;  Morphine;  Spine surgery;  Postoperative pain

Resumo

Justificativa e objetivos: A analgesia pós-operatória para cirurgias da coluna vertebral é difícil sem analgesia de controle do paciente (ACP) e instalações de monitoramento inadequadas. O objetivo foi estudar a eficácia da analgesia da administração intravenosa em dose baixa de fentanil e morfina para analgesia pós-operatória após cirurgias de fusão espinhal. Metodologia: Cem pacientes adultos submetidos a cirurgias de instrumentação da coluna vertebral foram distribuídos aleatoriamente em dois grupos: Grupo M (morfina) ou Grupo F (fentanil). Os pacientes receberam 0,02 mg / kg / h de morfina ou 0,3 mcg / kg / h de infusão de fentanil no pós-operatório. Se o paciente sentia dor, uma dose adicional em bolus de 0,04 mg / kg e 0,6 mcg / kg em bolus para morfina e fentanil, respectivamente, era administrada e anotada. O consumo de analgésico adicional foi registrado. O escore de sedação de Ramsay (RSS), o escore visual analógico (VAS), os parâmetros vitais e as complicações foram observados. Resultados: As características demográficas não revelaram diferença significativa entre os dois grupos. No grupo da morfina, 32 pacientes não precisaram de nenhuma dose em bolus adicional, 15 pacientes precisaram de uma dose em bolus e um paciente precisou de dois e três bolus cada. No grupo fentanil, dois, 24, 20 e quatro pacientes necessitaram de 0, 1, 2 e 3 doses em bolus, respectivamente. Não houve variações estatisticamente significativas nas características hemodinâmicas, como frequência cardíaca, pressão arterial e saturação de oxigênio, RSS e VAS. A taxa de complicações não foi significativa entre os grupos. Conclusão: A infusão contínua em baixas doses de morfina é mais eficaz do que o fentanil, com menos necessidade de analgésicos de resgate para analgesia pós-operatória. Ambos os medicamentos são seguros, sem complicações graves.

Palavras-chave

Fentanil; Morfina; Cirurgia na coluna; Dor pós-operatória

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