The characteristics of postoperative fentanyl effect-site concentration during intravenous fentanyl analgesia after posterior lumbar spine fusion

Tsunehisa Sato, MD; Mutsuhito Kikura, MD; Shigehito Sato, MD, PhD

doi:10.5055/jom.2013.0176

Authors

Tsunehisa Sato, MD
Mutsuhito Kikura, MD
Shigehito Sato, MD, PhD

DOI:

https://doi.org/10.5055/jom.2013.0176

Keywords:

fentanyl, intravenous fentanyl analgesia, effect-site concentration, simulation, lumbar spine fusion

Abstract

Objective: To examine the characteristics of postoperative fentanyl effect-site concentrations during intravenous analgesia in patients requiring or not requiring a fentanyl bolus and in patients with or without postoperative nausea and vomiting (PONV).

Design: Retrospective observational study.

Setting: University-affiliated general hospital.

Patients: Sixty patients who underwent posterior lumbar spine fusion.

Main outcome measures: The authors simulated the fentanyl effect-site concentration for 48 postoperative hours and compared it between patients who did and did not require a fentanyl bolus and between patients who did and did not experience PONV.

Results: At the end of anesthesia, the fentanyl effect-site concentration was similar between 37 (61.7 percent) patients requiring and 23 (38.3 percent) patients not requiring a postoperative fentanyl bolus (p = 0.97). Within the first 12 postoperative hours, the concentration decreased in both groups (p < 0.01). The fentanyl effect-site concentration was higher in patients requiring a postoperative fentanyl bolus (within 12 hours, 1.4 ± 0.32 ng/mL vs 0.89 ± 0.35 ng/mL; between 12 and 48 hours, 0.94 ± 0.19 ng/mL vs 0.57 ± 0.09 ng/mL) (p < 0.05). PONV occurred in 22 (36.6 percent) patients, but more so in women (68.2 percent; p < 0.01); PONV was similar between patients requiring and not requiring a fentanyl bolus (p = 0.78). Between the 12th and 48th postoperative hours, fentanyl effect-site concentrations were higher in patients with PONV (0.61 ± 0.10 ng/mL vs 0.57 ± 0.10 ng/mL, p = 0.03).

Conclusions: Patients needing a postoperative fentanyl bolus require a higher fentanyl effect-site concentration possibly because of individual variations, and PONV depends on the postoperative fentanyl effect-site concentration.

Author Biographies

Tsunehisa Sato, MD

Staff Anesthesiologist, Department of Anesthesiology, Hamamatsu Rosai Hospital, Hamamatsu, Japan

Mutsuhito Kikura, MD

Chief in Anesthesiology, Department of Anesthesiology, Hamamatsu Rosai Hospital, Hamamatsu, Japan

Shigehito Sato, MD, PhD

Professor and Chairman, Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, Shizuoka, Japan

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