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Anesth Analg 1988; 67:35-38
© 1988 International Anesthesia Research Society
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Effect of Naloxone Infusion on Analgesia and Respiratory Depression after Epidural Fentanyl

J. P. Gueneron, MD, Cl. Ecoffey, MD, P. Carli, MD, D. Benhamou, MD, and J. B. Gross, MD

Received from the Department of Anesthesiology of Bicétre Hospital, Université Paris-Sud, France, and the Department of Anesthesiology, Philadelphia Veterans Administration Medical Center, University of Pennsylvania, Philadelphia, Pennsylvania.

Abstract

The efficacy of two dosage regimens of intravenous naloxone were compared to avoid nonrespiratory side effects and respiratory depression and yet to preserve analgesia (maximum tolerance to periostal pressure over the tibia) after administration of 200 µgepidural fentanyl. Three groups of eight patients were studied: group 1 patients received a loading dose of 0.4 mg IV naloxone followed by naloxone infusion at a rate of 10 µg · kg–1 · hr–1. Group II patients received a loadingdose of 0.2 µg naloxone followed by a naloxone infusion af a rate of 5 µg · kg–1 · hr–1. Group III patients received a saline infusion at a rate of 20 ml/hr. Epidural fentanyl significantly increased tolerance to periostial pain in all three groups (respectively, +38 ± 20%, +36 ± 16%, and +35 ± 14%) (mean ± SD; P > 0.05). The naloxone infusion significantly reduced this effect in groups I and II, respectively, –40 ± 20% and –37 ± 28% below prenaloxone levels) (P > 0.05). Nonrespiratory side effects were also reversed in groups I and II. In group III, neither periostial analgesia nornonrespiratoy side effects were affected. The baseline slopes of VE/PET CO2 were 2.34 ± 1.01, 2.14 ± 0.66, and 2.68 ± 1.14 L · min–1 · mm Hg–1, respectively, in groups I, II, and III. Epidural fentanyl significantly decreased the slope below baseline levels in each group: –21 ± 1670, –22 ± 17%, and –19 ± 32%, respectively, in groups I, II, and III. Thirty minutes after the start of naloxone infusion the slope of VE/PET CO2 increased significantly in group 1 (+22 ± 14% from prenaloxone value) (P > 0.05), decreased significantly in group III (–11 ± 17% from prenaloxone value) (P > 0.05), and remained unchanged in group II (+10 ± 25% from prenaloxone value). Although high-dose naloxone reverses the respiratory depression associated with epidural fentanyl administration, there isa concomitant decrease in the quality of analgesia.

Key Words: PAIN—postoperative • ANALGESICS—fentanyl • ANTAGONISTS, NARCOTICS—naloxone • ANESTHETIC TECHNIQUES—epidural






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 1988 by the International Anesthesia Research Society.