<abstract xmlns="http://www.w3.org/1999/xhtml"><sec><h3>Background and aim</h3><p>Epidural administration of opioids with local anaesthetics is a popular choice for perioperative pain relief. But opioid induced side effects limit their use for postoperative analgesia. Hence, this study was designed to evaluate the effectiveness of epidural naloxone, an opioid receptor antagonist, in reducing PONV in patients receiving epidural fentanyl.</p></sec><sec><h3>Methods</h3><p>After obtaining the Institutional Ethics Committee approval and written informed consent, 46 patients, between 18–80 years, of either sex, with ASA physical status 1–3, undergoing lower limb orthopaedic surgeries were enlisted for this prospective, randomized, double blind comparative study. Subjects were allocated to one of the two groups and received epidurally, either fentanyl with bupivacaine (Group C, n = 23) or fentanyl with bupivacaine and naloxone 2 mcg (Group N, n = 25), for reducing postoperative pain. PONV score and Wong Bakers Scale (WBS) for pain score were recorded at 6, 12 and 18hrs, postoperatively.</p></sec><sec><h3>Results</h3><p>All patients were comparable with respect to age, gender, ASA PS, height, body weight as well as duration of surgery. A statistically significant decrease in PONV score was observed in Group N at 6 and 12 hours, postoperatively. The patients who required rescue antiemetic were also significantly lower in Group N at 6 and 12 hours. The mean WBS score for pain also showed significant reduction in Group N at 6 hours, postoperatively.</p></sec><sec><h3>Conclusion</h3><p>Concomitant use of low dose epidural naloxone and fentanyl is effective in attenuating PONV, besides enhancing analgesia in the earlypostoperative period.</p></sec></abstract>

Background and aimEpidural administration of opioids with local anaesthetics is a popular choice for perioperative pain relief. But opioid induced side effects limit their use for postoperative analgesia. Hence, this study was designed to evaluate the effectiveness of epidural naloxone, an opioid receptor antagonist, in reducing PONV in patients receiving epidural fentanyl.MethodsAfter obtaining the Institutional Ethics Committee approval and written informed consent, 46 patients, between 18–80 years, of either sex, with ASA physical status 1–3, undergoing lower limb orthopaedic surgeries were enlisted for this prospective, randomized, double blind comparative study. Subjects were allocated to one of the two groups and received epidurally, either fentanyl with bupivacaine (Group C, n = 23) or fentanyl with bupivacaine and naloxone 2 mcg (Group N, n = 25), for reducing postoperative pain. PONV score and Wong Bakers Scale (WBS) for pain score were recorded at 6, 12 and 18hrs, postoperatively.ResultsAll patients were comparable with respect to age, gender, ASA PS, height, body weight as well as duration of surgery. A statistically significant decrease in PONV score was observed in Group N at 6 and 12 hours, postoperatively. The patients who required rescue antiemetic were also significantly lower in Group N at 6 and 12 hours. The mean WBS score for pain also showed significant reduction in Group N at 6 hours, postoperatively.ConclusionConcomitant use of low dose epidural naloxone and fentanyl is effective in attenuating PONV, besides enhancing analgesia in the earlypostoperative period.

Epidural Naloxone Attenuates Fentanyl Induced PONV in Patients Undergoing Lower Limb Orthopaedic Surgeries. A Prospective Randomized Double-Blind Comparative Study

Azeezia Institute of Medical Sciences & Research

Romanian Journal of Anaesthesia and Intensive Care

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Background and aimEpidural administration of opioids with local anaesthetics is a popular choice for perioperative pain relief. But opioid induced side effects...

0		PONV Scores			P value 0	WBS PAIN Scores				P value

		1	2			1	2	3
6 HRS	GROUP N	21	2	0	0.011^*	18	5	0	0	0.007^*
6 HRS	GROUP C	12	8	3	0.011^*	9	14	0	0	0.007^*
12 HRS	GROUP N	18	3	2	0.026^*	5	15	3	0	0.403
12 HRS	GROUP C	9	9	5	0.026^*	2	16	5	0	0.403
18 HRS	GROUP N	17	3	3	0.060	3	10	9	1	0.991
18 HRS	GROUP C	12	10	1	0.060	3	9	10	1	0.991

	GROUP N	GROUP C	P VALUE
6 hrs	0.09 (0.288)	0.61 (0.722)	0.002^*
12 hrs	0.30 (0.635)	0.83 (0.778)	0.017^*
18 hrs	0.39 (0.722)	0.52 (0.593)	0.507

	GROUP N (23)	GROUP C (23)	P value
AGE	48.91(18.9)	56.22 (17.2)	0.179
SEX (M/F)	14 / 9	10/ 13	0.238
ASA STATUS (1/2/3)	14 / 9 / 0	13 / 8 / 2	0.351
HEIGHT (M)	164.04 (6.89)	162.09 (7.077)	0.348
WEIGHT (KG)	65.87 (7.7)	64.22 (6.8)	0.446
BMI (KG/M2)	23.34 (1.6)	24.4 (1.6)	0.900
PREV HISTORY OF PONV	5	4	0.738
MAXIMAL SENSORY BLOCK	T6 (T6–T8)	T6(T6–T8)	-
DURATION OF SURGERY	10.74 (18.15)	110.83 (27.8)	0.631

	GROUP N	GROUP C	P value
6 HOURS	0.22 (0.422)	0.61 (0.499)	0.006^*
12 HOURS	0.91 (0.596)	1.13 (0.548)	0.205
18 HOURS	1.35 (0.775)	1.39 (0.783)	0.851

Epidural Naloxone Attenuates Fentanyl Induced PONV in Patients Undergoing Lower Limb Orthopaedic Surgeries. A Prospective Randomized Double-Blind Comparative Study

Article Category: Research Article

Publicado en línea: 10 ago 2020

Páginas: 23 - 28

DOI: https://doi.org/10.2478/rjaic-2020-0009

Palabras clave
Naloxone, Fentanyl, PONV, Epidural, Wong Bakers Scale

© 2020 Zabrin Nimeeliya et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

Figure 2

Comparison of PONV and WBS pain scores between groups

Comparison of Mean PONV score at 6, 12 and 18 hrs between Group N and Group C

Patient characteristics

Comparison of Mean pain score at 6, 12 and 18 hrs between Group N and Group C

Epidural Naloxone Attenuates Fentanyl Induced PONV in Patients Undergoing Lower Limb Orthopaedic Surgeries. A Prospective Randomized Double-Blind Comparative Study

Article Category: Research Article

Publicado en línea: 10 ago 2020

Páginas: 23 - 28

DOI: https://doi.org/10.2478/rjaic-2020-0009

Palabras claveNaloxone, Fentanyl, PONV, Epidural, Wong Bakers Scale

© 2020 Zabrin Nimeeliya et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

Figure 2

Comparison of PONV and WBS pain scores between groups

Comparison of Mean PONV score at 6, 12 and 18 hrs between Group N and Group C

Patient characteristics

Comparison of Mean pain score at 6, 12 and 18 hrs between Group N and Group C

Palabras clave
Naloxone, Fentanyl, PONV, Epidural, Wong Bakers Scale