INTRATHECAL FENTANYL FOR POSTTHORACOTOMY PAIN

This double-blind, placebo-controlled study investigated the efficacy of intermittent doses of intrathecal fentanyl in 30 patients undergoin g thoracotomy. They were allocated randomly to three groups, two of wh ich had microspinal catheters inserted into the lumbar subarachnoid sp ace at the end of surgery; the third group acted as a control. Intrath ecal fentanyl or 0.9% saline was administered through the catheters an d all patients received morphine using a patient-controlled analgesia (PCA) system. Pain scores, morphine consumption and peak expiratory fl ow rates (PEFR) were recorded on an hourly basis. intrathecal fentanyl resulted in a faster onset of analgesia (mean visual analogue scale ( VAS) score at 1 h = 0.9 compared with 6.3 (95% confidence intervals fo r the difference -6.8, -4.0) for the other groups; P < 0.001) and sign ificantly lower pain scores at rest, on cough and on movement. PEFR va lues were consistently higher in the intrathecal fentanyl group. There were no cases of early or delayed respiratory depression.