A randomised control study comparing intravenous fentanyl vs nebulised fentanyl for postoperative pain relief in patients undergoing elective breast surgeries under general anesthesia

Abstract

Background: Relief of post operative pain with minimal side effects is a major goal during postanesthesia care. Intravenous fentanyl has been the gold standard for post operative pain relief. Fentanyl is a mu opioid receptor agonist characterised by high potency, rapid onset, short duration of action, lipid solubility and an apparent absence of serious side effects normally associated with opioids. Aim: To compare analgesic efficacy of nebulised fentanyl with intravenous fentanyl for post operative pain relief in patients undergoing breast surgeries under general anesthesia. Objectives: 1. To assess the analgesic efficacy of nebulised fentanyl in comparison to IV fentanyl for post-operative pain relief after breast surgeries. 2. To study Incidence and severity of side effects of fentanyl such as sedation, postoperative nausea and vomiting, respiratory depression, if any. Methodology: After our Hospital Research and Ethics Committee approval and obtaining informed written consent 90 patients aged between 20 and 65 years, belonging to ASA physical status I or II who were scheduled for elective breast surgeries under general anesthesia were included in this randomized control study. The patients were randomly assigned into three groups of 30 patients each to receive either Intravenous fentanyl 1mcg/kg (group C), or nebulised Fentanyl 2mcg/kg (Group N1) and nebulised Fentanyl 3mcg/kg (group N2). Results: These patients in both groups were comparable with respect to demographic characteristics age, sex, height, weight, ASA grading. Heart rates, SBP, DBP, MAP, SPO2 at basal value, after intubation, after extubation, and in PACU were similar and comparable in groups C, N1, N2. VAS scores were comparable at 0 min in groups C, N1, N2. At 5,10,15 min VAS scores were lower in control group than group N1 and N2. (P value The mean VAS scores increased in control group after 45 min where as in group N1 scores increased after 75min and in group N2 after 90min. The incidence of PONV was higher in group C compared to groups N1, N2. Statistically significant difference was observed between PONV grade among the three groups (P=0.093) Incidence of respiratory depression was compared in groups C,N1,N2. The P value is 0.0326 which is statistically significant.