The effect of fentanyl addition to bupivacaine on shivering and vomiting nausea in patients undergoing femoral fracture surgery by spinal anesthesia: A double-blind randomized clinical trial

Authors

1 Anesthesia and Pain Control Research Center, Jahrom University of Medical Sciences, Jahrom, Iran

2 Assistant Professor, Orthopedic Specialist, Jahrom University of Medical Sciences, Jahrom, Iran

3 Student Research Committee, Jahrom University of Medical Sciences, Jahrom, Iran

Abstract

Introduction: One of the most common complications after intrathecal anesthesia is chills during surgery. The second
most common complaint followed by intrathecal anesthesia is nausea and vomiting. The aim of this study was to evaluate the effect of adding fentanyl to bupivacaine on chills and vomiting nausea in patients undergoing femoral surgery by spinal anesthesia.
Materials and Methods: This randomized double-blind clinical trial study was performed on 40 patients aged 18 to 50 years with anesthesia classes 1 and 2 who were candidates for femoral orthopedic surgery. Patients were randomly
divided into two equal groups. The intervention group received 12.5 mg bupivacaine (2.5 cc) and 10 mg fentanyl (control group) and the control group received 12.5 μg bupivacaine (0.5 ml normal).
Patients with dry mouth, nausea, vomiting and shivering were evaluated at 1, 2, 6, 12 and 24 hours after surgery. Data analysis was performed using SPSS software version 21 and descriptive and inferential statistical tests.
Results: Forty patients undergoing spinal orthopedic surgery with spinal anesthesia participated in two equal groups (bupivacaine-fentanyl (n = 20) and bupivacaine (n = 20). There was no significant difference between fentanyl and bupivacaine in terms of recovery from nausea and postoperative times (p> 0.05) and differences between bupivacaine-fentanyl and bupivacaine in shivering at 6, 12, 18 and 24 hours postoperatively. There was no significant (p> 0.05).
Conclusion: In the present study, although fewer complications such as shivering and nausea and vomiting were
reported within minutes of the study in the fentanyl group, this decrease was not statistically significant.

Highlights

.Elia N, Culebras X, Mazza C, Schiffer E, Tramèr MR.Clonidine as an adjuvant to intrathecal localanesthetics forsurgery:systematic review ofrandomized trials. Reg Anesth Pain Med.2008;33(2):159–67.2. Nicholau D. Thepostanesthesia care unit,Postoperative nausea and vomiting. In: Aphel CC,editor. Miller's Anesthesia. 8th ed. Philadelphia, PA:Elsevier Churchill Livingstone; 2015. p. 2924-73.3. Lussos SA, Bader AM, Thornhill ML, Datta S. Theantiemetic efficacy and safety of prophylacticmetoclopramide for elective cesarean delivery duringspinal anesthesia. Reg Anesth. 1992;17(3):126–130.4. Kranke P, Eberhart LH. Possibilities and limitationsin the pharmacological management of postoperativenausea and vomiting. Eur J Anaesthesiol.2011;28(11):758–765.5. Kranke P, Eberhart LH, Roewer N, Tramer MR.Single-dose parenteral pharmacological interventionsfor the prevention of postoperative shivering: a
quantitative systematic review of randomizedcontrolled trials. Anesthesia and analgesia. 2004;99(3):718±27, table of contents. Epub 2004/08/31.https://doi.org/10.1213/01.ANE.0000130589.00098.CD PMID:15333401.6.Crowley LJ, Buggy DJ. Shivering and neuraxialanesthesia. Reg Anesth Pain Med. 2008;33(3):241–252.7. Roy JD, Girard M, Drolet P. Intrathecal meperidinedecreases shivering during cesarean delivery underspinal anesthesia. Anesth Analg. 2004;98(1):230–234.8. Bernard CM. Spinal and Epidural anesthesia. In:Barash Clinical Anaesthesia. 7th ed. Philadelphia:Lippincott Williams & Wilkins; 2013. p. 905-369. Delvecchio L, Bettinelli S, Klersy C, Allegri M,Cavalloro F, Braschi A. Comparing the efficacy and
safety of continuous epidural analgesia in abdominaland urological surgery between two opioids withdifferent kinetic properties: morphine and sufentanyl.Minerva Anestesiol 2008; 74(3): 69-76.10. Gauchan S, Thapa C, Prasai A, Pyakurel K, Joshi I,Tulachan J. Effects of intrathecal fentanyl as anadjunct to hyperbaric bupivacaine in spinal anesthesiafor elective caesarean section. Nepal Med Coll J2014; 16(1): 5-8.11. Liu S, Chiu AA, Carpenter R, Mulroy MF, AllenHW, Neal JM, et al. Fentanyl prolongs lidocainespinal anesthesia without prolonging recovery. AnesthAnalg 1995; 80(4): 730-734.
12. Liu SS, McDonald SB. Current issues in spinalanesthesia. Anesthesiology. 2001;94(5):888–906.13. Bao Z, Zhou C, Wang X, Zhu Y. Intravenousdexmedetomidine during spinal anaesthesia forcaesarean section: A meta-analysis of randomizedtrials. J Int Med Res. 2017;45(3):924–932.14. Onk D, Ayazoğlu TA, Kuyrukluyıldız U, Aksüt M,Bedir Z, Küpeli İ, Onk OA, Alagöl A. Effects of15Fentanyl and Morphine on Shivering During SpinalAnesthesia in Patients Undergoing EndovenousAblation of Varicose Veins. Medical science monitor:
international medical journal of experimental andclinical research. 2016;22:469.15. Techanivate A, Rodanant O, Tachawattanawisal W,Somsiri T. Intrathecal fentanyl for prevention ofshivering in cesarean section. Journal medical
association of thailland 2005;16;88(9):1214.16. Farzi F, Mirmansouri A, Nabi BN, Roushan ZA,Sani MN, Azad SM, Nemati M. Comparing the effectof adding fentanyl, sufentanil, and placebo withintrathecal bupivacaine on duration of analgesia andcomplications of spinal anesthesia in patientsundergoing cesarean section. Anesthesiology and painmedicine. 2017;7(5):1-8.17. Sadegh A, Tazeh-Kand NF, Eslami B. Intrathecalfentanyl for prevention of shivering in spinalanesthesia in cesarean section. Med J Islam RepubIran 2012; 26: 85-9.18.Singh R, Kundra S, Gupta S, Grewal A, Tewari A.Effect of clonidine and/or fentanyl in combinationwith intrathecal bupivacaine for lower limb surgery.Journal of anaesthesiology, clinical pharmacology.2015 Oct;31(4):485.19. Akinwale MO, Sotunmbi PT, Akinyemi OA.Analgesic effect of intrathecal neostigmine combinedwith bupivacaine and fentanyl. African journal ofmedicine and medical sciences. 2012 Jun;41(2):231.20. Uppal V, Retter S, Casey M, Sancheti S, MathesonK, McKeen DM. Efficacy of intrathecal fentanyl for
cesarean delivery: a systematic review and meta-analysis of randomized controlled trials with trialsequential analysis. Anesthesia & Analgesia. 2020 Jan1;130(1):111-25.21.Shin DW, Kim Y, Hong B, Yoon SH, Lim CS, YounS. Effect of fentanyl on nausea and vomiting incesarean section under spinal anesthesia: arandomized controlled study. Journal of InternationalMedical Research. 2019 Oct;47(10):4798-807.22. Golmohammadi M, Karami N, Tahmasebi R.INCIDENCE OF SHIVERING DURINGCESAREAN SECTION IN PATIENTS UNDERSPINAL ANESTHESIA WITH OR WITHOUTFENTANYL. Studies in Medical Sciences. 2020 Aug10;31(6):423-32.23. Balki M, Carvalh JC. Intraoperative nausea andvomiting during cesarean section under regionalanesthesia. Int J Obstet Anesth 2005; 14: 230–241.[PubMed] [Google Scholar

Keywords

.Elia N, Culebras X, Mazza C, SchifferE,TramèrMR.Clonidineasanadjuvanttointrathecallocalanestheticsforsurgery:systematic review ofrandomized trials. Reg Anesth Pain Med.2008;33(2):159–67.2. Nicholau D. The postanesthesia care unit,Postoperative nausea and vomiting. In: Aphel CC,editor. Miller's Anesthesia. 8th ed. Philadelphia, PA:Elsevier Churchill Livingstone; 2015. p. 2924-73.3. Lussos SA, Bader AM, Thornhill ML, Datta S. Theantiemetic efficacy and safety of prophylacticmetoclopramide for elective cesarean delivery duringspinal anesthesia. Reg Anesth. 1992;17(3):126–130.
4. Kranke P, Eberhart LH. Possibilities and limitationsin the pharmacological management of postoperative
nausea and vomiting. Eur J Anaesthesiol.2011;28(11):758–765.5. Kranke P, Eberhart LH, Roewer N, Tramer MR.
Single-dose parenteral pharmacological interventionsfor the prevention of postoperative shivering: a
quantitative systematic review of randomizedcontrolled trials. Anesthesia and analgesia. 2004;
99(3):718±27, table of contents. Epub 2004/08/31.https://doi.org/10.1213/01.ANE.0000130589.00098.CD PMID:15333401.
6.Crowley LJ, Buggy DJ. Shivering and neuraxialanesthesia. Reg Anesth Pain Med. 2008;33(3):241–252.
7. Roy JD, Girard M, Drolet P. Intrathecal meperidinedecreases shivering during cesarean delivery under
spinal anesthesia. Anesth Analg. 2004;98(1):230–234.8. Bernard CM. Spinal and Epidural anesthesia. In:
Barash Clinical Anaesthesia. 7th ed. Philadelphia:Lippincott Williams & Wilkins; 2013. p. 905-36
9. Delvecchio L, Bettinelli S, Klersy C, Allegri M,Cavalloro F, Braschi A. Comparing the efficacy and
safety of continuous epidural analgesia in abdominaland urological surgery between two opioids with
different kinetic properties: morphine and sufentanyl.Minerva Anestesiol 2008; 74(3): 69-76.
10. Gauchan S, Thapa C, Prasai A, Pyakurel K, Joshi I,Tulachan J. Effects of intrathecal fentanyl as an
adjunct to hyperbaric bupivacaine in spinal anesthesiafor elective caesarean section. Nepal Med Coll J
2014; 16(1): 5-8.11. Liu S, Chiu AA, Carpenter R, Mulroy MF, AllenHW, Neal JM, et al. Fentanyl prolongs lidocaine
spinal anesthesia without prolonging recovery. AnesthAnalg 1995; 80(4): 730-734.12. Liu SS, McDonald SB. Current issues in spinalanesthesia. Anesthesiology. 2001;94(5):888–906.13. Bao Z, Zhou C, Wang X, Zhu Y. Intravenousdexmedetomidine during spinal anaesthesia forcaesarean section: A meta-analysis of randomizedtrials. J Int Med Res. 2017;45(3):924–932.14. Onk D, Ayazoğlu TA, Kuyrukluyıldız U, Aksüt M,Bedir Z, Küpeli İ, Onk OA, Alagöl A. Effects of15Fentanyl and Morphine on Shivering During SpinalAnesthesia in Patients Undergoing EndovenousAblation of Varicose Veins. Medical science monitor:
international medical journal of experimental andclinical research. 2016;22:469.15. Techanivate A, Rodanant O, Tachawattanawisal W,Somsiri T. Intrathecal fentanyl for prevention ofshivering in cesarean section. Journal medical
association of thailland 2005;16;88(9):1214.16. Farzi F, Mirmansouri A, Nabi BN, Roushan ZA,Sani MN, Azad SM, Nemati M. Comparing the effectof adding fentanyl, sufentanil, and placebo withintrathecal bupivacaine on duration of analgesia andcomplications of spinal anesthesia in patientsundergoing cesarean section. Anesthesiology and painmedicine. 2017;7(5):1-8.17. Sadegh A, Tazeh-Kand NF, Eslami B. Intrathecalfentanyl for prevention of shivering in spinalanesthesia in cesarean section. Med J Islam RepubIran 2012; 26: 85-9.18.Singh R, Kundra S, Gupta S, Grewal A, Tewari A.Effect of clonidine and/or fentanyl in combinationwith intrathecal bupivacaine for lower limb surgery.Journal of anaesthesiology, clinical pharmacology.2015 Oct;31(4):485.19. Akinwale MO, Sotunmbi PT, Akinyemi OA.Analgesic effect of intrathecal neostigmine combinedwith bupivacaine and fentanyl. African journal ofmedicine and medical sciences. 2012 Jun;41(2):231.20. Uppal V, Retter S, Casey M, Sancheti S, MathesonK, McKeen DM. Efficacy of intrathecal fentanyl for
cesarean delivery: a systematic review and meta-analysis of randomized controlled trials with trialsequential analysis. Anesthesia & Analgesia. 2020 Jan1;130(1):111-25.21.Shin DW, Kim Y, Hong B, Yoon SH, Lim CS, YounS. Effect of fentanyl on nausea and vomiting incesarean section under spinal anesthesia: arandomized controlled study. Journal of InternationalMedical Research. 2019 Oct;47(10):4798-807.22. Golmohammadi M, Karami N, Tahmasebi R.INCIDENCE OF SHIVERING DURINGCESAREAN SECTION IN PATIENTS UNDERSPINAL ANESTHESIA WITH OR WITHOUTFENTANYL. Studies in Medical Sciences. 2020 Aug10;31(6):423-32.23. Balki M, Carvalh JC. Intraoperative nausea andvomiting during cesarean section under regionalanesthesia. Int J Obstet Anesth 2005; 14: 230–241.[PubMed] [Google Scholar