Abstract
Objectives
Articaine, a popular and rapidly acting local anesthetic in dentistry, has been also found to be beneficial in ambulatory spinal anesthesia. Analgesia in the intraoperative and immediate postoperative period may be further improved by adding fentanyl to the local anesthetic solution for spinal anesthesia. The aim was to evaluate dose-dependency of analgesia and side effects associated with intrathecal fentanyl additive to articaine for spinal anesthesia in knee arthroscopy patients.
Methods
In this randomized, observer- and patient-blinded study, 90 adult patients scheduled for elective ambulatory knee arthroscopy under spinal anesthesia were randomized into three groups: plain articaine 60 mg with saline (group AF0), articaine 60 mg with fentanyl 10 µg (group AF10) or 20 µg (group AF20) in a total volume of 1.9 ml. The blinded observer tested the sensory and the motor block, and performed telephone interviews on the first and seventh postoperative days.
Results
The median (IQR) duration of sensory block at the dermatomal level of T10 was significantly longer in groups AF10, 69 min (56) and AF20, 69 min (45) than in group AF0, 41 min (35) (p = 0.013). Motor block duration was similar in all groups (median 120 min). Group AF20 patients experienced pruritus significantly more often than patients in the other groups (p = 0.039). No acute or late anesthetic side effects occurred, and satisfaction with the anesthetic technique was the same in all groups (97% satisfied).
Conclusions
Fentanyl 10 or 20 µg as additive to articaine for spinal anesthesia prolonged the duration of sensory block significantly and similarly. Fentanyl 20 µg was more often associated with pruritus than fentanyl 10 µg.
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References
Vree TB, Gielen MJ. Clinical pharmacology and the use of articaine for local and regional anaesthesia. Best Pract Res Clin Anaesthesiol. 2005;19:293–308.
Snoeck M. Articaine: a review of its use for local and regional anesthesia. Local Reg Anesth. 2012;5:23–33.
Baeder C, Bähr H, Benoit W, Doerr BJ, Engelbart K, Hergott J, Kramer M, Schütz E, Scholz J, Springman FR, Wolf GL. Untersuchungen zur Verträglichkeit von Carticaine einem neuen Lokalanästhetikum. Prakt Anästh. 1974;9:147–52.
Leuschner J, Leblanc D. Studies on the toxicological profile of the local anaesthetic articaine. Arzneimittelforschung. 1999;49:126–32.
Hendriks MP, deWeert CJ, Snoeck MM, Hu HP, Pluim MA, Gielen MJ. Plain articaine or prilocaine for spinal anaesthesia in day-case knee arthroscopy: a double-blind randomized trial. Br J Anaesth. 2009;102:259–63.
Förster JG, Kallio H, Rosenberg PH, Harilainen A, Sandelin J, Pitkänen MT. Chloroprocaine vs. articaine as spinal anaesthetics for day-case knee arthroscopy. Acta Anaesthesiol Scand. 2011;55:273–81.
Bachmann M, Pere P, Kairaluoma P, Rosenberg PH, Kallio H. Comparison of hyperbaric and plain articaine in spinal anaesthesia for open inguinal hernia repair. Br J Anaesth. 2008;101:848–54.
Korhonen AM, Valanne JV, Jokela RM, Ravaska P, Korttila K. Intrathecal hyperbaric bupivacaine 3 mg + fentanyl 10 microg for outpatient knee arthroscopy with tourniquet. Acta Anaesthesiol Scand. 2003;47:342–6.
Ben-David B, Solomon E, Levin H, Admoni H, Goldik Z. Intrathecal fentanyl with small-dose dilute bupivacaine: better anesthesia without prolonging recovery. Anesth Analg. 1997;85:560–5.
Liu S, Chiu AA, Carpenter RL, Mulroy MF, Allen HW, Neal JM, Pollock JE. Fentanyl prolongs lidocaine spinal anesthesia without prolonging recovery. Anesth Analg. 1995;80:730–4.
Atallah MM, Helan MA, Shorrab AA. Hypobaric bupivacaine spinal anesthesia for cystoscopic intervention: the impact of adding fentanyl. Middle East J Anesthesiol. 2003;17:415–26.
Kairaluoma P, Bachmann M, Kallio H, Rosenberg P, Pere P. Hyperbaric articaine with or without fentanyl in spinal anaesthesia: patient- and observer-blinded comparison. Acta Anaesthesiol Scand. 2013;57:118–25.
Chung CJ, Yun SH, Hwang GB, Park JS, Chin YJ. Intrathecal fentanyl added to hyperbaric ropivacaine for Cesarean delivery. Reg Anesth Pain Med. 2002;27:600–3.
Kallio H, Snäll EV, Luode T, Rosenberg PH. Hyperbaric articaine for day-case spinal anaesthesia. Br J Anaesth. 2006;97:704–9.
Förster JG, Rosenberg PH, Harilainen A, Sandelin J, Pitkänen MT. Chloroprocaine 40 mg produces shorter spinal block than articaine 40 mg in day-case knee arthroscopic patients. Acta Anaesthesiol Scand. 2013;57:911–9.
Bachmann M, Pere P, Kairaluoma P, Rosenberg PH, Kallio H. Randomised comparison of hyperbaric articaine and hyperbaric low-dose bupivacaine along with fentanyl in spinal anaesthesia for day-case inguinal herniorrhaphy. Eur J Anaesthesiol. 2012;29:22–7.
Stocks GM, Hallworth SP, Fernando R, England AJ, Columb MO, Lyons G. Minimum local analgesic dose of intrathecal bupivacaine in labor and the effect of intrathecal fentanyl. Anesthesiology. 2001;94:593–8.
Varassi G, Celleno D, Capogna G, Costantino P, Emanuelli M, Sebastiani M, Pesce AF, Niv D. Ventilatory effects of subarachnoid fentanyl in the elderly. Anaesthesia. 1992;47:558–62.
Acknowledgements
This study was financially supported by research funds from Finska läkaresällskapet, Finland, and Helsinki University Hospital (EVO). The assistance of the research assistant Päivi Turunen is gratefully appreciated.
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Stenman, P., Salonen, M., Tarkkila, P. et al. Analgesia and side effects of the addition of 10 or 20 µg fentanyl to articaine in spinal anesthesia for knee arthroscopy: a randomized and observer-blinded study. J Anesth 31, 389–396 (2017). https://doi.org/10.1007/s00540-017-2344-0
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DOI: https://doi.org/10.1007/s00540-017-2344-0