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Analgesia for appendectomy: comparison of fentanyl and alfentanil in children
M Sfez1, Y Le Mapihan, J L Gaillard
1Department of Anaesthesia and Intensive Care, Jean Verdier Hospital, Bondy, France.
Insights
High-dose alfentanil provides effective intraoperative and postoperative analgesia in children undergoing appendectomy, similar to fentanyl. This study compared fentanyl and alfentanil in pediatric anesthesia.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pharmacology
Background:
- Opioid analgesics are crucial for managing pain during and after surgical procedures in children.
- Fentanyl and alfentanil are commonly used potent synthetic opioids with different pharmacokinetic profiles.
Purpose of the Study:
- To compare the efficacy of fentanyl and alfentanil for intraoperative and postoperative analgesia in pediatric patients undergoing appendectomy.
- To determine the equianalgesic potency ratio between alfentanil and fentanyl in this pediatric population.
Main Methods:
- A randomized study involving 39 pediatric patients undergoing appendectomy under etomidate-N2O vecuronium anesthesia.
- Three groups received different opioid regimens: fentanyl (Group F), alfentanil bolus (Group AB), or alfentanil infusion (Group AI).
- Efficacy was assessed by intraoperative heart rate changes, awakening time, and postoperative pain, analgesia duration, nausea, and vomiting incidence.
Main Results:
- The alfentanil bolus regimen (Group AB) was less effective in controlling intraoperative heart rate changes compared to fentanyl (P < 0.05).
- The equianalgesic cumulative dosage ratio of alfentanil to fentanyl was estimated to be between 1:10 and 1:13.
- Awakening time, duration of postoperative analgesia, and incidence of postoperative pain, nausea, and vomiting were similar across all groups.
Conclusions:
- High-dose alfentanil, administered either as a bolus or continuous infusion, is as effective as fentanyl for achieving intraoperative and postoperative analgesia in children undergoing appendectomy.
- Alfentanil represents a viable alternative to fentanyl for pediatric surgical analgesia, with comparable outcomes regarding recovery and side effects.
Abstract:
During etomidate-N2O vecuronium anaesthesia for appendectomy, three groups of 13 children received fentanyl as a 10 micrograms.kg-1 loading dose and 2 micrograms.kg-1 increments in Group F, alfentanil as a 100 micrograms.kg-1 initial loading dose and either 20 micrograms.kg-1 increments in Group AB or 1 microgram.kg-1.min-1 continuous infusion in Group AI. On the basis of intraoperative heart rate changes, the opioid regimen was less efficient in Group AB (P less than 0.05). Based upon equianalgesic cumulative dosage, the alfentanil/fentanyl potency ratio was in the range of 1/10 to 1/13. The awakening time was similar in all groups, as were the duration of postoperative analgesia, the incidence of postoperative pain and the incidence of nausea and vomiting. We conclude that high-dose alfentanil is as efficient as fentanyl for intra and postoperative analgesia in children undergoing appendectomy.