• The Korean Journal of Pain
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• v.11 no.1
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• pp.60-64
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• 1998

Background: We compared butorphanol and fentanyl for opioids use in patient-controlled analgesia(PCA) with ketorolac to determine a suitable drug combination for postoperative pain control. Methods: Sixty patients were equally divided into 2 Groups. Group 1 (n=30) butorphanol 10 mg with ketorolac 180 mg; Group 2 (n=30) fentanyl 1 mg with ketorolac 180 mg, diluting 100 ml solutions intravenously via PCA pump after total abdominal hysterectomy under general anesthesia. Total infusion dosage of PCA drug, VAS pain scores, and side effects of both group were manitored. Results: Total infusion dosages were as follows: (Group 1) butorphanol 8.3 mg with ketorolac 149.7 mg; (Group 2) fentanyl $646.6\;{\mu}g$ with ketorolac 116.2 mg. The two groups showed similar pain scores auld side effects. Conclusions : Both butorphanol and fentanyl were effective for postoperative pain control using PCA pump, but butorphanol was more economical. The putative potency ratio of butorphanol to fantanyl was 12.8 : 1.

• Korean Journal of Clinical Pharmacy
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• v.6 no.2
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• pp.24-27
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• 1996

In order to determine whether there was a clinically sufficient amount of drug remaining in used fentanyl patches, quantitative analysis of two different types of patches, each containing 2.5 mg (n=36) and 5 mg (n=20) was performed. After being used for approximately 72 hours by patients with cancer, each patch was put in the plastic bag and stored at $4^{\circ}C$ until analysis. Fentanyl remaining in patches was extracted with 50 ml methanol, diluted with water, and counted twice in a $\gamma-Counter$ (expressed as CPM). Patches that originally contained 2.5 mg and 5 mg of fentanyl were shown to have $0.48{\sim}1.86\;mg\;(mean:\;1.03\;mg,\;41.16\%)\;and\;0.37{\sim}3.95\;mg\;(mean:\;2.37\;mg,\;47.33\%)$ after use, respectively. A wide interpatient variability was observed in the rate of fentanyl release from patches although the application period was standardized to 72 hours. Since a significant amount of drug remained in the discarded patches, it is highly recommended that patients dispose used ones under supervision to prevent abuse or misuse of the narcotic drug.

• YAKHAK HOEJI
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• v.44 no.2
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• pp.189-192
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• 2000

We examined a dermal pharmacokinetics for a new SYC-fentanyl patch in rabbits. Determination of fentanyl in the plasma was performed using a gas chromatography with nitrogen-phosphorus detection system and a capillary column. One patch per animal (fentanyl 2.5 mg) was applied to clipped back skin for 72 hours. The plasma fentanyl concentration profile of SYC-patch was similar to that of a conventional patch (Durogesi $c^{R}$, Janssen Co.). No significant difference was observed in the pharmacokinetic parameters, the area under the concentration-time curve (AU $C^{0-}$72hrs/) and the total area under the first moment-time curve (AUM $C^{0-}$7hrs/), between the two patch types. The AU $C^{0-}$7hrs/ and AUM $C^{0-}$72hrs/ of durogesi $c^{R}$ were 183.3$\pm$46.28 ng＊hr/ml and 6,450$\pm$1,939ng＊h$r^2$/ml, and those of SYC-fentany patch were 217.2$\pm$50.51$\pm$ng＊hr/ml and 8,022$\pm$2,245ng＊h$r^2$/ml, respectively (n=3). This result indicates that the new SYC patch has a similar bioavailability compared to durogesi $c^{R}$ patch. Therefore, the SYC-patch may be considered as a bioequivalent fentanyl patch.patch.tch.

• The Korean Journal of Pain
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• v.29 no.2
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• pp.110-118
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• 2016

Background: Nefopam is a non-opioid, non-steroidal, centrally acting analgesic drug. The concomitant use of opioids and nefopam is believed to have many advantages over the administration of opioids alone for postoperative pain management. We conducted a randomized, double-blind study to determine the fentanyl-sparing effect of co-administration of nefopam with fentanyl for postoperative pain management via patient controlled analgesia (PCA). Methods: Ninety female patients who underwent laparoscopic total hysterectomy under general anesthesia were randomized into 3 groups, Group A, fentanyl $1,000{\mu}g$; Group B, fentanyl $500{\mu}g$ + nefopam 200 mg; and Group C, fentanyl $500{\mu}g$ + nefopam 400 mg, in a total volume of 100 ml PCA to be administered over the first 48 h postoperatively without basal infusion. The primary outcome was total fentanyl consumption during 48 h; secondary outcomes included pain scores and incidence of side effects. Results: Eighty-one patients were included in the analysis. The overall fentanyl-sparing effects of PCA with concomitant administration of nefopam during the first 48 h postoperatively were 54.5% in Group B and 48.9% group C. Fentanyl use was not significantly different between Groups B and C despite the difference in the nefopam dose. There were no differences among the three groups in terms of PCA-related side effects, although the overall sedation score of Group B was significantly lower than that of Group A. Conclusions: The concomitant administration of nefopam with fentanyl for postoperative pain management may allow reduction of fentanyl dose, thereby reducing the risk of opioid-related adverse effects.

• The Korean Journal of Pain
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• v.13 no.1
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• pp.60-66
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• 2000

Background: For terminal cancer pain management, controlled-release oral morphine (morphine sulfate tablet, MST) is a simple and convenient regimen. Recently, fentanyl transdermal therapeutic system (F-TTS, transdermal fentanyl) has been developed and became one of the alternative ways of providing adequate pain relief. This open prospective study was designed to compare the analgesic efficacy and safety of MST and transdermal fentanyl in the management of terminal cancer pain. Methods: In this open comparative and randomized study, 64 terminal cancer patients received one treatment for 15 days, controlled-release oral morphine (MST group) or fentanyl transdermal therapeutic system (F-TTS group). Daily diaries about the vital sign, visual analogue scale (VAS) for pain, opioids requirement, co-anagesics, adjuvant drugs and adverse effects were completed with 24 patients in MST group, 18 patients in F-TTS group. Results: The majority of patients in both treatment groups were late-stage cancer and their distribution was not different in both groups. Daily opioids requirement was 126.4 mg in MST uced in F-TTS group (P<0.05). The incidence of nausea, vomiting and constipation was lower in F-TTS group (P<0.05). Patients satisfaction was similar, but F-TTS patient group favored continous use of same treatment compared with MST group after the study was finished. Conclusions: Transdermal fentanyl seems to be safe and similar analgesic effect to controlled-release oral morphine for the control of the terminal cancer patients. However, transdermal fentanyl provides a simpler and more convenient especially in respect to constipation, nausea & vomiting. To determine the exact analgesic effect, cost-effectiveness and complications, controlled trials should be followed.

• The Korean Journal of Pain
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• v.18 no.2
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• pp.138-141
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• 2005

Background: There have been many attempts to alleviate pain after surgery, but there is no common approach to the control of postoperative pain. The use of epidural opioids, with local anesthetics, has been a widely employed formula to date. Ketamine, an N-methyl-d-aspartate receptor antagonist, has an excellent analgesic effect. Although there have been many reports on the dose and route of administrating analgesics, there have been few concerning the continuous epidural infusion of ketamine with fentanyl. We designed this study to find the effects of ketamine compared to those of epidurally injected bupivacaine and fentanyl, and used this trial to study any potential side effects. Methods: In a double blind trial, 55 patients received either fentanyl, $0.3{\mu}g/kg/h$ (Group F), or fentanyl, $0.3{\mu}g/kg/h$, and ketamine, 0.1 mg/kg/h (Group FK), added to 0.125% bupivacaine, at rates as high as 2 ml/h, for patient controlled epidural analgesia (PCEA) following a transabdominal hysterectomy. Ten minutes before the operation, patients received 10 ml of 0.125% bupivacaine, with either 0.5 mg/kg ketamine or the same amount of normal saline with $50{\mu}g$ fentanyl added. The pain scores and the side effects were recorded at 1, 3, 6 and 24 hour post operation. Results: There were no differences in the pain scores or side effects between the two groups. Conclusions: We failed to find any effect of the addition of epidural ketamine compared to the that of the bupivacaine and fentanyl formula. However, it is suggested that further investigations will be required on the dose and route of administration.

• The Korean Journal of Pain
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• v.7 no.2
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• pp.181-187
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• 1994

The MAC($ED_{50}$)values of enflurane, fentanyl, and nalbuphine-enflurane under 65% $N_2O$ were determined in 76 Sprague-Dawley rats using the tail-clamp technique to compare the equipotent effects of intravenous and inhaled anesthetics. The rats were divided into 3 groups: enfluarne, fentanyl, and nalbuphine-enflurane. Results were as follows: 1) The MAC value of enflurane under 65% $N_2O$ was $1.160{\pm}0.05%$ and after subcutaneous nalbuphine 20 mg/kg injection, the values were 1.08% at 60min and 0.99% at 90min. 2) The lowest $ED_{50}$ for fentanyl was 26.8 ${\mu}g$/kg at 15 min, and the $ED_{50}$, 30, 45, and 60min after the injection were 36.2, 39.7, and 44.7 ${\mu}g$/kg, respectively. 3) On arterial blood gas analysis under 65% $N_2O$-1MAC($ED_{50}$), fentanyl and nalbuphine-enflurane groups showed mild increase in $PaCO_2$, but there were no significant differences among 3 groups. Fentanyl group showed significant difference in pH compared with enfluarane and nalbuphine-enflurane groups. 4) Rats injected with high dose fentanyl(above $40{\mu}g$) displayed rigidity and respiratory depression.

• The Korean Journal of Pain
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• v.8 no.2
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• pp.244-250
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• 1995

Many clinical and laboratory experiments have been developed to prevent or decrease post-operative pain. One of these methods is pre-operative administration of opioid. Recently there have been differing and debatable results reported of pre-operative treatment for post-operative pain management. It was our study to determine whether pre-operative epidural fentanyl prevented central facilitation or wind up of spinal cord from nociceptive afferent input through c-fibers. We evaluated the effect of epidural fentanyl 50 mcg 10 minutes before operation and 10 minutes before the end of surgery. 28 parturient women for Cesarean Section were randomly allocated to receive the epidural fentanyl either at 10 minutes before operation (Group 1, n=14) or 10 minutes before the end of surgery (Group 2, n=14). All of the 28 parturient women were anesthetized with epidural block using (22 ml of) 2% lidocaine supplemented with light general anesthesia ($N_2O$ 2 L/min-$O_2$, 2 L/min), we controlled post-operative pain with epidural PCA(patient controlled analgesia) infusion of meperidine and 0.07% bupivacaine. The action duration of epidural fentanyl from the end of surgery to the first requirement of analgesics with epidural PCA were not significantly different between the two groups. No significant differences between two groups were observed in VAS pain score at 1, 2, 3, 6, 12, 24, and 48 hours after the operation. The number of self administration of narcotics with PCA during 48 hours after surgery were the same between the two groups. The hourly infusion rates of demerol were the same. Pre-operative administration of fentanyl was not clinically effective compared to administration just before the end of surgery for postoperative pain control.

• Journal of Dental Anesthesia and Pain Medicine
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• v.18 no.1
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• pp.47-56
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• 2018

Background: The purpose of this study is to investigate the effects of administration order when a sedative drug (midazolam) and an opioid analgesic drug (fentanyl) is applied for moderate intravenous (IV) sedation in dentistry. Methods: A retrospective chart review was conducted in one dental clinic during its transition from a midazolam-first to a fentanyl-first protocol for dental procedures requiring moderate IV sedation. Physiological parameters, drug administration times, patient recovery times, drug dosages, and patient recall and satisfaction were investigated for differences. Results: A total of 76 charts (40 midazolam-first and 36 fentanyl-first administrations), were used in the analysis. Administering midazolam first resulted in an average 4.38 min (52%) decrease in administration times (P < 0.001), and a decrease in procedural recollection immediately following the procedure (P = 0.03), and 24 to 48 hours later (P = 0.009). Administering fentanyl first required an average of 2.43 mg (29%) less midazolam (P < 0.001). No significant differences were found for change in vital signs, minimum oxygen saturation levels, recovery times, and patient satisfaction (P > 0.05). Oxygen saturation levels did not drop below 90% for either group; however, 5 cases in the fentanyl-first group fell to between 90% and 92%, compared with 0 cases in the midazolam-first group. Conclusions: The administration order of fentanyl and midazolam may have different effects on patients and the sedation procedure. Findings from this study should be used to facilitate discussion among dental practitioners and to guide additional research investigating this topic.

• Archives of Pharmacal Research
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• v.21 no.1
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• pp.70-72
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• 1998

Fentanyl of a potent anilidopiperidine analgesic has been synthesized from a simple phenyle-thylamine by four step sequence. The key part of this synthesis involves an efficient construc-tion of phenylethylpiperidone skeleton via aminomethano desilyation-cyclization followed by Swern oxidation.