Patient-controlled cervical epidural fentanyl compared with patient-controlled i.v. fentanyl for pain after pharyngolaryngeal surgery

Background. Analgesia after pharyngolaryngeal surgery is commonly provided through the i.v. route. The aim of the study was to compare cervical epidural administration of fentanyl with the i.v. route for postoperative analgesia after pharyngolaryngeal surgery. Methods. In a randomized double-blind study 42 patients received fentanyl via patient-controlled analgesia (PCA) either through the i.v. route (PCA-IV group, n=22) or through the cervical epidural route (PCA-Epid group, n=20). Identical PCA settings were used in the two groups (bolus dose: 1.5 mu g kg(-1), bolus: 25 mu g, lockout interval: 10 min, maximum cumulative dose: 400 mu g per 4 h). Analgesia at rest and during swallowing was evaluated using a visual analogue scale. Results. Analgesia at rest was better in the PCA-Epid groupthan in the PCA-IV group but only 2 and 6 h after surgery (P < 0.02). There was no difference in analgesia during swallowing. Cumulative doses of fentanyl were similar {PCA-Epid group: 1412 mu g (912), PCA-IV group: 1287 mu g (1200) [median (IQR)]}. The Pa-o2 showed a significant decrease between the preoperative and postoperative period, but this decrease was identical in the two groups [PCA-IV-group: 11.47 (2.4) kPa vs 8.27 (0.9) kPa; PCA-Epid group: 11.33 (1.9) kPa vs 9.20 (2.4) kPa for preoperative and postoperative period respectively]. Conclusions. The study results show that cervical epidural analgesia provides marginally better pain relief at rest with no decrease in the fentanyl consumption. The use of the cervical epidural administration of fentanyl is questionable because of the possible complications of the technique.