Canadian Journal of Anesthesia, Vol 29, 587-592, Copyright © 1982 by Canadian Anesthesiologists' Society

Analgésie Péridurale À Dose Élevée de Fentanyl: Échec de la Méthode Pour la Kinésithérapie Post-Opératoire Précoce Avec Chirurgie du Genou

¹ Département d'Anesthésie-Réanimation, Hôpital Avicenne, 125, route de Stalingrad, 93009, Bobigny, France

Following orthopedic surgery of the lower limb, ten patients were given fentanyl 5 µg·kg^-1 in a single epidural injection. Almost complete analgesia (P<0.001) was rapidly obtained. The total period of analgesia was rather short (182.3 ± 32.1 min). The maximal analgesia period was 87 ± 8.34 minutes. Despite this high dose of fentanyl (245 to 450 µg), in five patients the passive mobilization of the knee following surgery was extremely painful and, for that matter, impossible in three of them. Such high doses of fentanyl entail the risk of respiratory depression as respiratory rate is decreased (P < 0.01) and the PCO₂ is increased (P < 0.01).

Fentanyl should not be used at such high dosage and should probably not be preferred to morphine, considering that the duration of analgesia is short, that the analgesic score is identical to that obtained with lower doses or with longer lasting narcotics, that it does not prevent passive mobilization pains and that it entails a definite risk of respiratory depression.