Canadian Journal of Anesthesia

, 46:872

Intraoperative high dose fentanyl induces postoperative fentanyl tolerance

  • Yuan-Yi Chia
  • Kang Liu
  • Jhi-Joung Wang
  • Mei-Ching Kuo
  • Shung-Tai Ho
Reports of Investigation



In a randomized, double-blind clinical trial, we compared the postoperative analgesic effect and dose consumption of fentanyl after intraoperative high dose and low dose fentanyl administration.


Sixty ASA class I to II female patients undergoing total abdominal hysterectomy (TAH), were randomly allocated to receive either 1 μg· kg−1 (low dose group, n = 30) or 15 μg· kg−1 (high dose group, n = 30) fentanyl during induction of anesthesia. Anesthesia depth was maintained with inhalation of halothane in the low dose group, or combined with 100 μg· hr−1 fentanyliv in the high dose group. Postoperative pain was treated with an intravenous patient-controlled analgesia system and was assessed with a visual analog pain score at rest.


Patients in the high dose group had higher pain intensity at four and eight hours postoperatively, more fentanyl consumption and a greater incidence of emesis in the postoperative period of 16 hr than those in the low dose group (P < 0.05). Heart rate, blood pressure, and respiratory rate were similar between the two groups. Conclusion: Our results suggest that acute fentanyl tolerance develops after administration of high dose fentanyl during surgery and, consequently, results in a higher postoperative pain intensity and greater fentanyl consumption.



Comparer, dans un essai clinique randomisé, à double insu, l’effet analgésique postopératoire et la consommation de fentanyl après l’administration peropératoire de forte et faible dose de fentanyl.


Soixante patientes de classes I et II ASA devant subir une hystérectomie abdominale totale (HAT) ont été réparties au hasard et ont reçu, soit 1 μg· kg−1 (groupe de faible dose, n = 30), soit 15 μg· kg−1 (groupe de forte dose, n = 30) de fentanyl pendant l’induction de l’anesthésie. La profondeur de l’anesthésie a été maintenue avec l’inhalation d’halothane dans le groupe à faible dose, ou en combinaison avec 100 μg· hr−1 de fentanyliv, dans le groupe à forte dose. La douleur postopératoire a été soulagée avec une analgésie intraveineuse contrôlée par la patiente et évaluée, au repos, à l’aide d’une échelle visuelle analogue.


Les patientes qui ont reçu la forte dose ont connu des douleurs plus intenses quatre et huit heures après l’opération, ont pris davantage de fentanyl et ont eu une plus grande incidence de vomissements dans les 16 h qui ont suivi l’opération, que celles qui ont reçu une faible dose (P < 0,05). La fréquence cardiaque, la tension artérielle et le rythme respiratoire n’ont pas présenté de différence intergroupe.


Les résultats suggèrent qu’une tolérance soudaine au fentanyl se développe après l’administration peropératoire d’une forte dose et qu’elle entraîne, par conséquent, des douleurs postopératoires plus intenses et une plus grande consommation de fentanyl.


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Copyright information

© Canadian Anesthesiologists 1999

Authors and Affiliations

  • Yuan-Yi Chia
    • 1
    • 2
  • Kang Liu
    • 1
    • 2
  • Jhi-Joung Wang
    • 3
  • Mei-Ching Kuo
    • 1
    • 2
  • Shung-Tai Ho
    • 3
  1. 1.Department of AnesthesiaVeterans General Hospital-KaohsiungTaiwanRepublic of China
  2. 2.Department of Anesthesiology, School of MedicineNational Yang-Ming UniversityTaipei, TaiwanR.O.C.
  3. 3.Department of AnesthesiologyTri-Service General Hospital National Defense Medical CenterTaipei, TaiwanR.O.C.

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