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Effect of Intraoperative Continuous I.V. Fentanyl on Tourniquet Induced Cardiovascular Changes and Postoperative Preemptive Analgesia in Total Knee Replacements  

Lee, Jong Won (Department of Anesthesiology and Pain Medicine, Hanyang University College of Medicine)
Jun, Jong Hun (Department of Anesthesiology and Pain Medicine, Hanyang University College of Medicine)
Kim, Young Sun (Department of Anesthesiology and Pain Medicine, Hanyang University College of Medicine)
Cheong, Mi Ae (Department of Anesthesiology and Pain Medicine, Hanyang University College of Medicine)
Shim, Jae Chol (Department of Anesthesiology and Pain Medicine, Hanyang University College of Medicine)
Kim, Kyo Sang (Department of Anesthesiology and Pain Medicine, Hanyang University College of Medicine)
Publication Information
The Korean Journal of Pain / v.18, no.2, 2005 , pp. 165-170 More about this Journal
Abstract
Background: It is difficult to treat tourniquet-induced hypertension despite adequate anesthesia, and the mechanism of that is not known. And it may be possible that intraoperative continuous infusion of opioid induces preemptive analgesia postoperatively. We investigated the effect of intraoperative continuous i.v. fentanyl on tourniquet induced cardiovascular changes and postoperative preemptive analgesia in total knee replacements. Methods: Sixty patients were randomly assigned to two groups; In study group ($1.5{\mu}g/kg$ loading and $0.5{\mu}g/kg/hr$ continuous infusion of fentanyl before skin incision and tourniquet inflation) and control group (no treatment). Anesthesia was maintained with enflurane (1-2 MAC) and 50% nitrous oxide in oxygen. Arterial pressure and heart rate were compared between two groups. They received postoperative pain treatment with patient-controlled analgesia (PCA) with fentanyl during the postoperative 48 hours after total knee replacement. Visual analog scale (VAS) scores at either rest or movement were used to assess pain. Total fentanyl dose delivered, number of PCA requests, supplemental analgesics, overall satisfaction score and adverse events were evaluated. Results: There were no significant differences between the two groups on cardiovascular changes by tourniquet induced pain effect. VAS, PCA delivered dose and PCA demands at movement in the 24-48 hour decreased in study group compared with control group (P < 0.05). But there were no significant differences between the two groups on the other time periods except 24-48 hour's patient satisfaction and adverse events. Conclusions: We suggest that intraoperative continuous i.v. fentanyl infusion dose not affect cardiovascular change by tourniquet induced pain. But it may induce preemptive analgesia postoperatively.
Keywords
intraoperative continuous fentanyl infusion; postoperative preemptive analgesia; tourniquet induced cardiovascular change;
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  • Reference
1 Bradford EM: Haemodynamic changes associated with the application of lower limb tourniquets. Anaesthesia 1969; 24: 190-7.
2 Farah RS, Thomas PS: Sympathetic blockade and tourniquet pain in surgery of the uppet exttemity. Anesth Analg 1987; 66: 1033-5.
3 Lurie SD, Reuben SS, Gibson CS, DeLuca PA, Maciolek HA: Effect of clonidine on upper extremity tourniquet pain in healthy volunteers. Reg Anesth Pain Med 2000; 25: 502-5.
4 Woolf C]: Evidence for a central component of post-injury pain hypersensitivity. Nature 1983; 306: 68G-8.
5 Coderre T], Catz ], Vaccarino AL, Melzack R: Contribution of central eutoplasticity to pathological pain: review of clinical and experimental evidence. Pain 1993; 52: 259-85.
6 Woolf C], Chong MS: Preemptive analgesia: treating postoperative pain by preventing the establishment of central sensitization. Anesth Analg 1993; 77: 362-79.
7 Valli H, Rosenberg PH: Effects of three anaesthesia methods on haemodynamicresponses connected with the use of thigh tourniquet in orthopaedic patients. Acta Anaesrhesiol Scand 1985; 29: 142-7.
8 Cabell CA: Does ketorolac produce preemptive analgesic effect in laparoscopic ambulatory surgery patients' AANA ] 2000; 68: 343-9.
9 Menigaux C, Fletcher D, Dupont X, Guignard B, Guirimand F, Chauvin M: The benefits of intraoperative small-dose ketamine on postoperative pain after anterior cruciate ligament repair. Anesth Analg 2000; 90: 129-35.
10 Flisberg P, Tornebrandt K, Walther B, Lundberg ]: A comparison of the effects on postoperative pain relief of epidural analgesia started before or after surgery. Eur ] Anaesthesiol 2000; 17: 627-33.
11 Altintas F, Bozkurt P, Ipek N, Yucel A, Kaya G: The efficacy of pre- versus postsurgical axillary block on postoperative pain in paediatric patients. Paediatr Anaesrh 2000; 10: 23-8.
12 Doyle E, Bowler GM: Pre-emptive effect of multimodal analgesia in thoracic surgery. Br] Anaesth 1998; 80: 147-51.
13 Millar AY, Mansfield MD, Kinsella J: Influence of timing of morphine administration on postoperative pain and analgesic consumption. Br ] Anaesth 1998; 81: 373-6.
14 Moiniche S, Kehlet H, Dahl ]B: A qualitative and quantitative systematic review of preemptive analgesia for postoperative pain relief: the role of timing of analgesia. Anesthesiology 2002; 96: 725-41.
15 Gignac E, Manninen PH, Gelb AW: Comparison of fentanyl, sufentanil and alfentanil during awake craniotomy for epilepsy. Can] Anaesth 1993; 40: 421-4.
16 Rousso M, Wexler MR, Weinberg H, Vatashky E, Aronson B: Subcutaneous ring anaesthesia in the prevention of tourniquet pain in hand sutgery. Hand 1978; 10: 317-20.
17 Romsing ], Ostergaard D, Walther-Larsen S, Valentin N: Analgesic efficacy and safety of preoperative versus postoperative ketorolac in paediatric tonsillectomy. Acta Anaesthesiol Scand 1998; 42: 770-5.
18 McQuay HJ: Pre-emptive analgesia: a systematic review of clinical studies. Ann Med 1995; 27: 249-56.
19 Campbell WI, Kendrick RW: Pre-emptive analgesia using local anaesthesia: a study in bilaterally symmetrical surgery. Br] Anaesth 1997; 79: 657-9.
20 Dahl ]B, Kehlet H: The value of pre-emptive analgesia in the treatment of postoperative pain. Br ] Anaesth 1993; 70: 434-9.
21 Kissin 1: Preemptive analgesia: terminology and clinical relevance. Anesrh Analg 1994; 79: 809-10.
22 Hagenouw RR, Bridenbaugh PO, van Egmond ], Stuebing R: Tourniquet pain: a volunteer study. Anesth Analg 1986; 65: 1175-80.
23 Campbell WI, Kendrick RW, Ramsay-Baggs P, McCaughey W: The effect of pre-operative administration of bupivacaine compared with its postoperative use. Anaesthesia 1997; 52: 1212-6.
24 Subramaniam B, Pawar DK, Kashyap L: Pre-emptive analgesia with epidural morphine or morphine and bupivacaine. Anaesth Intensive Care 2000; 28: 392-8.
25 Norman PH, Daley MD, Lindsey RW: Preemptive analgesic effects of ketorolac in ankle fracture surgery. Anesthesiology 2001; 94: 599603.
26 Valli H, Rosenberg PH, Kytta], Nurminen M: Arterial hypertension associated with the use of a tourniquet with either general or regional anaesthesia. Acta Anaesthesiol Scand 1987; 31: 279-83.
27 Griffin M], Hughes D, Knaggs A, Donnelly MB, Boylan ]F: Late-onset preemptive analgesia associated with preincisional largedose alfentanil. Anesrh Analg 1997; 85: 1317-21.
28 Tetzlaff ]E, Yoon H], Walsh M: Regional anaesthetic technique and the incidence of tourniquet pain. Can] Anaesth 1993; 40: 591-5.
29 Tschaikowsky K, Hemmerling T: Comparison of the effect of EMLA and semicircular subcutaneous anaesthesia in the prevention of tourniquet pain during plexus block anaesthesia of the arm. Anaesthesia 1998; 53: 390-3.
30 Rosenblatt RM, Hetherington A: Failute of transcutaneous electrical stimulation to alleviate experimental tourniquet pain. Anesth Analg 1981; 60: 720-2.
31 Satsumae T, Yamaguchi H, Sakaguchi M, Yasunaga T, Yamashita S, Yamamoto S, et al: Preoperative small-dose ketamine prevented tourniquet-induced arterial pressure increase in orthopedic patients under general anesthesia. Anesth Analg 2001; 92: 1286-9.
32 Dahl V, Ernoe PE, Steen T, Raeder ]C, White PF: Does ketamine have preemptive effects in women undergoing abdominal hysterectomy procedures? Anesrh Analg 2000; 90: 1419-22.