EPIDURAL FENTANYL, ADRENALINE AND CLONIDINE AS ADJUVANTS TO LOCAL-ANESTHETICS FOR SURGICAL ANALGESIA - METAANALYSES OF ANALGESIA AND SIDE-EFFECTS

Background: The risk/benefit ratio of adding fentanyl, adrenaline and clonidine to epidural local anaesthetics for improving intraoperative analgesia is unclear. This meta-analysis was performed to clarify this issue. Methods: Trials retrieved by search were considered if they we re prospective, controlled, epidural analgesia (without combining gene ral anaesthesia) was planned and occurrence of pain during surgery or side-effects were reported. Papers entered meta-analysis if they reach ed a predefined minimum quality score. Pooled odds ratios (OR) and con fidence intervals (CI) were computed. P<0.05 was considered as signifi cant. Results: Eighteen trials were included in the analysis for fenta nyl. Fentanyl decreased the likelihood of pain (OR=0.21, 95% CI=0.15-0 .30, P<0.001) and increased the incidence of pruritus (OR=5.59, 95% CI =3.12-10.05, P<0.001) and sedation (OR=1.88, 95% CI=1.19-2.98, P=0.003 ), compared to control (local anaesthetic without fentanyl). Fentanyl had no effect on respiratory depression, nausea, vomiting and Apgar sc ore. One case of respiratory depression of a newborn was observed. Bec ause of the very low number of trials selected, evaluation of adrenali ne and clonidine was not feasible. Conclusion: The analysis of current literature shows that the addition of fentanyl to local anaesthetics for intraoperative epidural analgesia is safe and advantageous. The re duction in the incidence of pain during surgery is quantitatively high and therefore clinically significant. Side-effects are mild. Randomiz ed, controlled trials have to be performed in order to clarify the rol e of adrenaline and clonidine as epidural adjuvants for surgical analg esia.