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157: Comparison of epidural fentanyl and sufentanil administration for postoperative pain control in infants and children undergoing urologic surgery
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147. Effect of fentanyl on glutamate release from nucleus accumbens to a rat model of postoperative pain C. Pourzitaki1, C. Sardeli1, F. Aroni2, E. Logotheti2, G. Papazisis1, E. Haftoura2, P. Arabatzis2, D. Kouvelas1 1Department of Pharmacology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece, 2Department of Anesthesiology, Achillopouleion General Hospital of Volos, Volos, Greece Background & Aims: Injection of formalin into the hind paw of the rat induces a nociceptive behavioural response, which is considered to be an animal model of postoperative pain in humans. The aim of the present study is to evaluate the glutamate release from nucleus accumbens, as it is critically involved in the development of tolerance to opioids, with continuous fentanyl i.v. infusion after strong nociceptive stimulation with formalin injection. Methods: Twenty four male adult Wistar rats 250-300g, were used. Under pentobarbital (40 mg/kg, i.p.) and ketamine (50 mg/ kg, i.p.) anaesthesia, an intrathecal catheter was implanted subcutaneously in right hind paw of the rat, a silicone catheter in their left jugular vein and a push pull cannula, stereotaxically, into the right nucleus accumbens. The animals were divided into 4 groups as follows: group 1 (n⫽6) received only saline through both catheters, group 2 (n⫽6) received saline through the intrathecal catheter and fentanyl intravenously. Group 3 and 4 (n⫽6 both) had the formalin test but received saline and fentanyl i.v. respectively. Fentanyl dose was 50 g/Kg. To investigate whether fentanyl i.v. infusion alters glutamate release in the nucleus accumbens during formalin test induced pain, the push-pull superfusion technique was used. The glutamate in the superfusate was determined by HPLC combined with fluorimetric detection. ANOVA test was used for the analysis of the data. Results: The results are indicating that, in the nucleus accumbens, the release rate of glutamate is increased after saline and formalin induced pain but in groups that received formalin the rates differs significantly. Fentanyl administration abolishes the phenomenon both in saline and formalin treated groups. Conclusions: According to our results, glutamatergic pathway in nucleus accumbens plays a significant role in nociception from formalin induced pain. Fentanyl administration can prevent this elevated glutamate release after a single i.v. infusion.
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Postoperative Pain Management
153
157. Comparison of epidural fentanyl and sufentanil administration for postoperative pain control in infants and children undergoing urologic surgery J.E. Cho1, S.Y. Ban1, J.E. Kim1, H.K. Kil2 1Anesthesiology & Pain Medicine, Yonsei University College of Medicine, Seoul, South Korea, 2Anesthesiology & Pain Medicine, Anesthesia & Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea Background & Aims: In postoperative epidural analgesia, diluted local anesthetics are commonly combined with opioids to ensure that a minimal dose of each is used. This also has the merit of additive analgesic effect with fewer adverse effects. Fentanyl and sufentanil are both lipophilic opioids having rapid onset time, more predictable and reliable analgesia, and less adverse effects. The aim of this study was to compare the effects of ropivacaine with fentanyl or sufentanil for postoperative epidural analgesia in infants and children. Methods: 64 children undergoing urologic surgery, aged 3-96 ms and weighing 4.9-21.9 kg were randomly allocated into two groups, fentanyl (Group F, n⫽32) or sufentanil (Group S, n⫽32). After general anesthesia, epidural puncture and catheterization was performed at lumbar interspace. Before surgery 1% lidocaine 0.3 ml/kg with fentanyl 0.5 mcg/kg or sufentanil 0.1 mcg/kg was administered through the epidural catheter. After the bolus dose, continuous infusion was started at a rate of 2 ml/hr with 0.15% ropivacaine containing fentanyl (0.2 mcg/kg/hr) or sufentanil (0.04 mcg/kg/hr). The degree of pain was assessed using six-graded faces pain scale and behavioral scale (FLACC: Face, Legs, Activity, Cry, Consolability) at postoperative 1 hr and 24 hr. All adverse effects were recorded: hypoxia (SpO2 of 90 or less); degree of sedation (5-point scale; 1⫽awake and alert, 5⫽asleep, unresponsive to stimuli); pruritus; nausea or vomiting; motor weakness. Data were analyzed with independent t-test and Chi-square test. Results: FLACC score at 1 hour (0.9 ⫾ 1.3) and the incidence of pruritus (4 cases) within 24 hours were significantly higher in Group S compare to Group F. None of the patients showed hypoxia or motor weakness. Conclusion: Considering the cost-effectiveness, sufentanil was not superior to fentanyl in postoperative epidural analgesia for infants and children.
147. Effect of fentanyl on glutamate release from nucleus accumbens to a rat model of postoperative pain C. Pourzitaki1, C. Sardeli1, F. Aroni2, E. Logotheti2, G. Papazisis1, E. Haftoura2, P. Arabatzis2, D. Kouvelas1 1Department of Pharmacology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece, 2Department of Anesthesiology, Achillopouleion General Hospital of Volos, Volos, Greece Background & Aims: Injection of formalin into the hind paw of the rat induces a nociceptive behavioural response, which is considered to be an animal model of postoperative pain in humans. The aim of the present study is to evaluate the glutamate release from nucleus accumbens, as it is critically involved in the development of tolerance to opioids, with continuous fentanyl i.v. infusion after strong nociceptive stimulation with formalin injection. Methods: Twenty four male adult Wistar rats 250-300g, were used. Under pentobarbital (40 mg/kg, i.p.) and ketamine (50 mg/ kg, i.p.) anaesthesia, an intrathecal catheter was implanted subcutaneously in right hind paw of the rat, a silicone catheter in their left jugular vein and a push pull cannula, stereotaxically, into the right nucleus accumbens. The animals were divided into 4 groups as follows: group 1 (n⫽6) received only saline through both catheters, group 2 (n⫽6) received saline through the intrathecal catheter and fentanyl intravenously. Group 3 and 4 (n⫽6 both) had the formalin test but received saline and fentanyl i.v. respectively. Fentanyl dose was 50 g/Kg. To investigate whether fentanyl i.v. infusion alters glutamate release in the nucleus accumbens during formalin test induced pain, the push-pull superfusion technique was used. The glutamate in the superfusate was determined by HPLC combined with fluorimetric detection. ANOVA test was used for the analysis of the data. Results: The results are indicating that, in the nucleus accumbens, the release rate of glutamate is increased after saline and formalin induced pain but in groups that received formalin the rates differs significantly. Fentanyl administration abolishes the phenomenon both in saline and formalin treated groups. Conclusions: According to our results, glutamatergic pathway in nucleus accumbens plays a significant role in nociception from formalin induced pain. Fentanyl administration can prevent this elevated glutamate release after a single i.v. infusion.
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Postoperative Pain Management
153
157. Comparison of epidural fentanyl and sufentanil administration for postoperative pain control in infants and children undergoing urologic surgery J.E. Cho1, S.Y. Ban1, J.E. Kim1, H.K. Kil2 1Anesthesiology & Pain Medicine, Yonsei University College of Medicine, Seoul, South Korea, 2Anesthesiology & Pain Medicine, Anesthesia & Pain Research Institute, Yonsei University College of Medicine, Seoul, South Korea Background & Aims: In postoperative epidural analgesia, diluted local anesthetics are commonly combined with opioids to ensure that a minimal dose of each is used. This also has the merit of additive analgesic effect with fewer adverse effects. Fentanyl and sufentanil are both lipophilic opioids having rapid onset time, more predictable and reliable analgesia, and less adverse effects. The aim of this study was to compare the effects of ropivacaine with fentanyl or sufentanil for postoperative epidural analgesia in infants and children. Methods: 64 children undergoing urologic surgery, aged 3-96 ms and weighing 4.9-21.9 kg were randomly allocated into two groups, fentanyl (Group F, n⫽32) or sufentanil (Group S, n⫽32). After general anesthesia, epidural puncture and catheterization was performed at lumbar interspace. Before surgery 1% lidocaine 0.3 ml/kg with fentanyl 0.5 mcg/kg or sufentanil 0.1 mcg/kg was administered through the epidural catheter. After the bolus dose, continuous infusion was started at a rate of 2 ml/hr with 0.15% ropivacaine containing fentanyl (0.2 mcg/kg/hr) or sufentanil (0.04 mcg/kg/hr). The degree of pain was assessed using six-graded faces pain scale and behavioral scale (FLACC: Face, Legs, Activity, Cry, Consolability) at postoperative 1 hr and 24 hr. All adverse effects were recorded: hypoxia (SpO2 of 90 or less); degree of sedation (5-point scale; 1⫽awake and alert, 5⫽asleep, unresponsive to stimuli); pruritus; nausea or vomiting; motor weakness. Data were analyzed with independent t-test and Chi-square test. Results: FLACC score at 1 hour (0.9 ⫾ 1.3) and the incidence of pruritus (4 cases) within 24 hours were significantly higher in Group S compare to Group F. None of the patients showed hypoxia or motor weakness. Conclusion: Considering the cost-effectiveness, sufentanil was not superior to fentanyl in postoperative epidural analgesia for infants and children.