Comparison of fentanyl and droperidol mixture (neuroleptanalgesia II) withmorphine on clinical outcomes in unstable angina patients

The objective of the study was to compare the influence of a fentanyl and d roperidol mixture (neuroleptanalgesia) with morphine on the in-hospital ins tability, development of acute myocardial infarction (AMI), and mortality d uring a 30-day and 12-month follow-up in unstable angina patients. The stud y was performed in 112 unstable angina patients. In addition to standard th erapy for unstable angina (aspirin, heparin, nitroglycerin, and oxygen), 53 patients (63.2 +/- 9.7 years; 32 males) were randomized to receive neurole ptanalgesia (0.025 mg fentanyl and 1.25 mg droperidol in a volume of 1 mL) and 59 patients (58.6 +/- 11.5 years; 41 males) to receive morphine. Neurol eptanalgesia was started IV with 2 mL and could be followed by 1 mL every 4 hours. Morphine was started IV with 10 mg and could be followed by 5 mg ev ery 4 hours up to angina resolution during 24 hours of hospitalization. Ano ther 1 mL of neuroleptanalgesia or 5 mg of morphine could be administered o n demand if angina lasted or reappeared earlier than the next scheduled dos e. Odds ratios with 95% confidence intervals (95% CI) adjusted for the age, sex, smoking, previous myocardial infarction, and hypertension were evalua ted for all study outcomes. The odds ratios for clinical in-hospital instab ility (5.93, 95% CI: 2.49-14.15; P = 0.0001), 12-month AMI development (3.5 7, 95% CI: 1.51-8.45; P = 0.0038), and 12-month mortality (6.00, 95% CI: 1. 63-22.09; P = 0.0070) were significantly increased in the neuroleptanalgesi a group compared with the patients on morphine. It is concluded that neurol eptanalgesia negatively influences disease course, AMI development, and tot al mortality in unstable angina patients.