Clinical effects of intrathecal fentanyl on shoulder tip pain in laparoscopic total extraperitoneal inguinal hernia repair under spinal anaesthesia: A double-blind, prospective, randomized controlled trial

• Published in: Journal of international medical research Vol. 41; no. 4; pp. 1160 - 1170
• Main Authors: Sung, Tae-Yun, Kim, Min-Su, Cho, Choon-Kyu, Park, Dong-Ho, Kang, Po-Soon, Lee, Sang-Eok, Kwon, Won-Kyoung, Woo, Nam-Sik, Kim, Seong-Hyop
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-08-2013; Sage Publications
• Subjects: Abdomen; Abdomen - pathology; Abdomen - surgery; Adult; Aged; Analgesics, Opioid - therapeutic use; Anesthesia, Spinal - adverse effects; Biological and medical sciences; Bupivacaine - therapeutic use; Diseases of the osteoarticular system; Double-Blind Method; Female; Fentanyl - therapeutic use; Gastroenterology. Liver. Pancreas. Abdomen; Hernia, Inguinal - pathology; Hernia, Inguinal - surgery; Humans; Injections, Spinal; Intraoperative Complications; Laparoscopy; Male; Medical sciences; Middle Aged; Miscellaneous. Osteoarticular involvement in other diseases; Other diseases. Semiology; Pharmacology. Drug treatments; Prospective Studies; Shoulder Pain - etiology; Shoulder Pain - prevention & control; spinal anaesthesia; Laparoscopic total extraperitoneal inguinal hernia repair; intrathecal fentanyl; Agonist; Diseases of the osteoarticular system; μ Opioid receptor; Fentanyl; Opiates; Painful shoulder; Narcotic analgesic; Intrathecal administration; Randomization; Regional anesthesia; Abdominal disease; Double blind study; Phenylpiperidine derivatives; Repair; Inguinal hernia
• ISSN: 0300-0605; 1473-2300
• DOI: 10.1177/0300060513490083

Objective
The study evaluated the clinical intraoperative effects of intrathecal administration of fentanyl on shoulder tip pain in patients undergoing laparoscopic total extraperitoneal inguinal hernia repair (TEP) under spinal anaesthesia.
Methods
Patients undergoing TEP were allocated in a double-blinded, prospective, randomized manner to two groups. Spinal anaesthesia was induced by intrathecal administration of 2.8 ml of 0.5% hyperbaric bupivacaine (14 mg) in the control group and with 2.6 ml of 0.5% hyperbaric bupivacaine (13 mg) and 10 µg fentanyl (0.2 ml) in the experimental group.
Results
The quality of muscle relaxation, adequacy of operative space and incidence of pneumoperitoneum were similar in the two groups (n = 36 per group). Compared with the control group, the experimental group had significantly fewer cases of hypotension (12 [33.3%]) versus 23 [63.9%]) and shoulder tip pain (nine [25%] versus 18 [50%]). Intraoperative shoulder tip pain was more severe in the control group than in the experimental group.
Conclusions
Addition of intrathecal fentanyl to local anaesthetic can relieve shoulder tip pain with no change in complications, especially hypotension, during TEP under spinal anaesthesia.