Use of Fentanyl During Percutaneous Coronary Interventions: Safety and Drawbacks

Over the last years, fentanyl, a potent synthetic μ receptor-stimulating opioid, has become one of the most used drugs for both procedural analgesia and sedation in patients undergoing coronary angiography (CA) and/or percutaneous coronary intervention (PCI). However, few studies have been performed to evaluate the efficacy and the impact of this drug in patients with coronary artery disease (CAD) treated with PCI. Most of the previous studies have investigated the self-reported discomfort pain, demonstrating that patients premedicated with fentanyl generally reported a lower pain/discomfort when compared to placebo, benzodiazepines, or local anesthesia at the site of the artery cannulation, without significant variation in the hemodynamic response. The biochemical properties of fentanyl have been used to prevent the radial arterial spasm, which represents one of the major causes of the access site cross-over during PCI, experienced when radial artery cannulation has failed and successful access can be obtained only switching to an alternative arterial route, as the ulnar or the femoral artery. However, some unresolved problems, as fentanyl-induced hypothermia and delayed absorption of P2Y₁₂ inhibitors required further investigations.