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Preoperative "fentanyl challenge" as a tool to estimate postoperative opioid dosing in chronic opioid-consuming patients.
- Source :
-
Anesthesia and analgesia [Anesth Analg] 2005 Aug; Vol. 101 (2), pp. 389-395. - Publication Year :
- 2005
-
Abstract
- Unlabelled: When opioids are used for postoperative pain control, it is useful to define the dose-response relationship for analgesia and respiratory depression. We studied 20 chronically opioid-consuming patients having elective multilevel spine fusion. Preoperatively, each patient received a fentanyl infusion of 2 microg x kg(-1) x min(-1) until the respiratory rate was <5 breaths/min. Pharmacokinetic simulations were used to estimate the effect site concentration at the time of respiratory depression and to predict the patient-controlled analgesia settings that would provide an effect-site fentanyl concentration that was 30% of the concentration associated with respiratory depression. Postoperatively, patient-controlled analgesia settings were adjusted to achieve 2-3 demand doses per hour. At steady-state patient-controlled analgesia settings, arterial blood gases and plasma fentanyl levels were measured. Sixteen patients required no adjustment or one patient-controlled analgesia adjustment. The median arterial Pco(2) level was 41 mm Hg and the interquartile range was 39-46 mm Hg. Plasma fentanyl levels demonstrated a significant correlation to the estimated effect-site concentration associated with respiratory depression determined during the preoperative fentanyl challenge. A preoperative fentanyl challenge used with pharmacokinetic simulations may be a useful tool to individualize the administration of analgesics to chronically opioid-consuming patients.<br />Implications: In chronically opioid-consuming patients, doses causing respiratory depression and analgesia may differ from those in opioid-naive individuals. A preoperative infusion of fentanyl, used in conjunction with pharmacokinetic simulation, may be a valuable tool for identifying clinical end-points, such as respiratory depression and analgesia, and individualizing postoperative treatment of pain in patients who chronically consume opioids.
- Subjects :
- Analgesics, Opioid therapeutic use
Blood Gas Analysis
Computer Simulation
Dose-Response Relationship, Drug
Female
Humans
Hydrocodone administration & dosage
Hydrocodone therapeutic use
Infusions, Intravenous
Male
Middle Aged
Morphine administration & dosage
Morphine therapeutic use
Opioid-Related Disorders metabolism
Oxycodone administration & dosage
Oxycodone therapeutic use
Preoperative Care
Prospective Studies
Spinal Fusion
Analgesics, Opioid administration & dosage
Fentanyl adverse effects
Fentanyl pharmacokinetics
Opioid-Related Disorders complications
Pain, Postoperative drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 0003-2999
- Volume :
- 101
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Anesthesia and analgesia
- Publication Type :
- Academic Journal
- Accession number :
- 16037150
- Full Text :
- https://doi.org/10.1213/01.ANE.0000156563.25878.19