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Background and purpose: Lidocaine is an intermediate acting local anesthetic agents used very much in epidural anesthesia and has less risk of cardiac or CNS problems compared with bupivacaine. This study evaluated the duration of motor and sensory block of epidural anesthesia with lidocaine alone, lidocoine plus epinephrine and lidocaine plus fentanyl.
Materials and Methods: In this double blind study 60 ASA I and II patients that scheduled for elective orthopedic operation were classified by block randomization in to three groups. Epidural anesthesia had been prescribed with 380 mg 2% lidocaine plus 1ml normal saline 0.9% for group N, 380 mg 2% Lidocaine plus 100 m/g (1ml from 1/10000 solution) for group E and 380 mg 2% lidocaine plus 500 m/g fentanyl for group F. The onset of sensory block and duration of motor and sensory block were recorded.
Results: The mean onset time of sensory block in three groups were the same and about 8-9 minutes . The duration of complete motor block in group E (46.5 min) and F (45.3 min) were significantly higher than group N (22.5 min). The duration of sensory block in group E (117 min) was higher than group N and F (102 min). Hypotension happened in 40%, 50% and 60% of cases and bradycardia in 10%, 25% and 30% of cases of groups N, E and F respectively.
Conclusion: The results of this study showed that there were no effects on onset time of epidural sensory block with epinephrine or fentanyl as an additive to lidocaine 2% but they have glittery direct effects on the duration of motor block. However, epinephrine can increase the duration of sensory block with lidocaine in epidural anesthesia. We suggest that in cases that relaxation and complete motor block is needed in epidural anesthesia epinephrine or fentanyl be added to lidocaine.

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Background and purpose: Ït has been found that the use of different drugs for laryngoscopy preparation and tracheal intubation results in controversy. The aim of this study is to compare the haemodynamic effects of remifentanil with fentanyl for tracheal intubation in patients undergoing coronary artery bypass grafting (ÇÂBG).
Materials and methods: This is a randomized and double-blind study. We recruited 64 patients undergoing coronary artery bypass surgery. Subjects received in 3 separate groups: remifentanil, 5 microgram/kg, Fentanyl, 8 microgram/kg, and routine medication respectively. Systolic and diastolic blood pressure, heart rate and mean arterial pressure were measured during, before and after tracheal intubation and immediately, 1, 3, 5, 10, minutes after intubation. Patients were monitored for haemodynamic changes using electrocardiography.
Results: Sixty four patients were enrolled in the study. Twenty four patients age at 66 ± 5.7 (60-84) years, received remifentanil, 23 patients with mean age of 65.7 ± 6 (60-80) years made up the routin group, and 17 patients with mean age of 65 ± 4.8 (61-76) years received fentanyl. Blood pressure and heart rate decreased after induction of anaesthesia in all groups. SBP and DBP significantly decreased in remifentanil group in comparison with other groups (p= 0.01, 0.03). Ït was pssoble to control hemodynamic response to tracheal intubation in all groups, although it was better in remifentanil group than other groups.
Çonclusion: Âlthough the incidence of hypotension was higher, 0.5 microgram/kg of Remifentanil 8 microgram/kg of fentanyl and routine method (sufentanil) were all effective to attenuate patients’ blood pressure in response to tracheal intubation up to 3 minutes after intubation.

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Background and purpose: Colonoscopy is an invasive short-lasting procedure causes the patient's considerable pain, discomfort and anxiety. Therefore, various types of sedation and analgesia techniques have been used during the procedure. The aim of this study was to compare the quality of sedation/analgesia of propofol-fentanyl and midazolam-meperidine combinations in patients undergoing elective colonoscopy. Materials and methods: Eighty-three patients scheduled for elective colonoscopy under sedation were enrolled in this randomized double-blind study. In propofol-fentanil group, patients received fentanyl (1 µg/kg) and propofol (0.5 mg/kg) followed by an infusion of 25 µg/kg/min. Group midazolam-meperidine received meperidine (0.7 mg/kg) with midazolam (0.03 mg/kg). The assessment included measurements of quality of sedation, heart rate, blood pressure, oxygen saturation, and evaluation of the recovery time. Results: The systolic blood pressure, heart rate, and percent of blood oxygen saturation (SPO2) remined stable during the procedure. Sedation level was higher in propofol-fentanil group. Recovery time was 12.68 ± 4.90 and 25.75 ± 2.07 minutes in the propofol-fentanil and midazolam-meperidine groups, respectively (P = 0.023). Conclusion: Propofol-fentanil can provide better sedation, satisfaction and analgesia than midazolam-meperidine during colonoscopy .Therefore, it can be recommend in patients scheduled for elective colonoscopy.

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Background and purpose: Fentanyl is commonly used for spinal analgesia during labor, but it is associated with high incidence of pruritus. This study was performed to evaluate the effect of intravenous injection of prophylactic granisetron on the incidence and severity of pruritus induced by intrathecal fentanyl among the parturients undergoing cesarean section under spinal anesthesia.

Materials and methods: This double-blind clinical trial was performed in 136 ASA I or II (based on the American Society of Anesthesiology Classification) women undergoing elective caesarean section under spinal anesthesia with 0.5% hyperbaric bupivacaine (10 mg) and fentanyl (25 µg). After parturition and clamping of the umbilical cord, the subjects were randomized to receive 1 mg of IV granisetron (group G) or 0.9% saline (group S). To compare the incidence and severity of pruritus between the two groups, Fisher’s exact test and t-test were performed, respectively, using SPSS version 21.

Results: The overall incidence of pruritus was 3.74% (group S=5.76% and group G=1.72%). In the G group, the incidence of pruritus was significantly different and lower in recovery (P=0.01). There were significant differences between the groups in terms of severity of pruritus during surgery, which was lower in the G group (P=0.005).

Conclusion: This study showed that granisetron as the 5-hydroxytryptamine (serotonin) subtype 3 antagonists may reduce the incidence and severity of pruritus induced by intrathecal opioid.

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Background and purpose: Spinal anesthesia is commonly used in transurethral resection of the prostate (TURP). To reduce the complications of spinal anesthesia, opioids could be helpful in decreasing the amount of anesthetic drug. The aim of this study was to evaluate the effect of low doses of bupivacaine and fentanyl on the levels of sensory block and motor block.
Materials and methods: A clinical trial was conducted in 80 TURP candidates in Babol Rouhani Hospital, 2016-2017. They were randomly divided into two groups (n= 40 per group) to receive either 7.5 mg bupivacaine 0.5% and 25 mcg of fentanyl (BF group) or 10mg bupivacaine 0.5% (B group). Duration of anesthesia, motor block (using Bromage score), pain intensity during the operation, and mean arterial pressure were recorded. Data were analyzed in SPSS V20.
Results: There were no significant differences between the two groups in duration of anesthesia and mean arterial pressure (P<0.05). The mean score for pain was significantly lower in BF group than the B group (P=0.007). The levels of sensory block in group B were significantly higher than the BF group (P<0.001). Also, motor block return time and recovery time were significantly shorter in BF group than those in B group (P<0.001).
Conclusion: According to the current study, administration of bupivacaine and fentanyl can cause appropriate level of sensory block and could relief pain during TURP. Also, some complications such as long-term motor block and long-term staying in recovery would reduce.
 
(Clinical Trials Registry Number: IRCT201702226148N4)

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Background and purpose: Opioid analgesics cause bradycardia and respiratory depression.  The aim of this study was to investigate the efficacy of diclofenac suppository on pain and dose reduction of injectable fentanyl in patients undergoing colonoscopy.
Materials and methods: In a clinical trial, 500 patients undergoing colonoscopy were randomly divided into two groups to receive either diclofenac or glycerin (placebo) administered 30 min before colonoscopy. Five minutes before colonoscopy, fentanyl (50 μg/iv) was administered, and then, if pain persisted during colonoscopy, fentanyl 50 μg was administered as a rescue. Baseline demographic and clinical data and other information, including cecal arrival time, patients’ and gastroenterologist’s satisfaction, pain intensity based on visual analogue scale (VAS), rescue dose of fentanyl, frequency of hypotension and apnea were compared between the two groups.
Results: The groups were similar in age, sex, and baseline clinical parameters (P> 0.05). Cecal arrival time was shorter in the group that received diclofenac (10.59±3.8 min) than the placebo group (12.41±2.5 min) (P= 0.035). Mean pain score was found to be lower in diclofenac group (3.2±54.2) than the placebo group (5.10±2.8) (P <0.0001). Frequency of fentanyl administration in diclofenac group (6%) was lower than that in placebo group (24.8%) (P <0.0001). Frequency of hypotension and apnea events were observed to be lower in the group that received diclofenac (P< 0.05).
Conclusion: In this study, diclofenac suppository had positive effects on reducing the pain intensity, the dose of fentanyl, and side effects, therefore, it is recommended in colonoscopy analgesia protocols.
 
(Clinical Trials Registry Number: IRCT2016092629976N1)
 

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Background and purpose: Dexmedetomidine is a new sedative that has analgesic and sympatholytic effects. This study was performed to compare the hemodynamic response of dexmedetomidine and fentanyl after endotracheal intubation in lumbar spine surgery.
Materials and methods: In a double-blind clinical trial, 80 patients aged 20-65 years candidates for elective spinal surgery were randomly divided into two groups to receive either dexmedetomidine or fentanyl. In case group, dexmedetomidine (0.5 mcg/kg) and in control group fentanyl (1 mcg/kg in 50 ml of normal saline) were administered 10 minutes before endotracheal intubation. Heart rate and mean arterial pressure were measured at 1, 3, 5, and 10 minutes after intubation. Endotracheal intubation quality and first time of postoperative pain were also measured using Copenhagen score and numerical rating scale, respectively.
Results: Heart rates at 1, 3, 5, and 10 minutes after intubation were 77.60±8.29, 75.73±8.12, 76.44±9.62, and 76.43±7.87 in dexmedetomidine group and 82.7±11.31, 82.08±10.91, 79.93±10.0, and 74.28±14.04 in fentanyl group, respectively (P˂0.001). Mean arterial pressure at 1, 3, 5, and 10 minutes after intubation were 87.45±18.68, 82.25±13.78, 81.78±13.77, and 79.13±14.81 in dexmedetomidine group and 94.95±19.40, 92.23±17.51, 88.28±15.20, and 83.18±13.43 in fentanyl group, respectively (P˂0.001). Quality of intubation was not found to be significantly different between the two groups (P= 0.10). The mean of first time postoperative pain was 9.34±7.11 minutes in fentanyl group and 13.66±10.21 minutes in dexmedomidine group (P= 0.03).
Conclusion: This study showed that hemodynamic changes after endotracheal intubation were less in patients who received dxmedetomidine compared to those that received fentanyl.
 
(Clinical Trials Registry Number: IRCT20111010007752N11)
 

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 Background and purpose: Appropriate drug regimen during colonoscopy is one of the matters of concern in anesthesia. This study was conducted to compare the efficacy of propofol-ketamine combination and propofol-fentanyl in colonoscopy.
Materials and methods: In a single-blind randomized clinical trial, 200 patients aged 18-60 years candidate for colonoscopy, were randomly allocated into two groups to receive either fentanyl-propofol (PF) or ketamine-propofol (PK) using block randomization. Recovery time (end of injection until Steward Score was 6) as the primary outcome and vital signs, complications, total dose of propofol, and satisfaction of the doctor performing the colonoscopy as secondary consequence were compared between the two groups.
Results: Recovery time was 2.97 ± 0.89 min in the fentanyl-propofol group and 8.84 ± 1.73 min in ketamine-propofol group (P<0.001). Systolic and diastolic blood pressure and heart rate significantly decreased in the fentanyl-propofol group compared with the other group (P <0.001) which was persistent until five minutes after colonoscopy. Restlessness was seen in 28 patients receiving propofol-ketamine but no patient in fentanyl-propofol group developed this condition (P <0.001). Satisfaction of the doctor performing the colonoscopy and propofol dose were significantly better in patients that received ketamine-propofol (P<0.05).
Conclusion: Fentanyl-propofol combination was associated with faster recovery time and less restlessness than the ketamine-propofol compound, but the latter combination is recommended as it led to better hemodynamic stability, greater satisfaction of the doctor, and reduced dose of propofol.

 (Clinical Trials Registry Number: IRCT20190529043750N1)
 

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Background and purpose: Colonoscopy is a standard method for the diagnosis and treatment of colorectal diseases. The aim of the present study was to compare the analgesic effect of oral oxycodone and intravenous fentanyl in patients undergoing colonoscopy.
Materials and methods: This study was conducted as a randomized clinical trial in 80 patients aged 20 to 69 years who were candidates for colonoscopy in two equal groups. Patients in the first group received oral oxycodone and intravenous normal saline, while the second group received oral placebo and 50 micrograms of intravenous fentanyl. 0.5 mg/kg propofol was administered intravenously to both groups. If pain occured, 10 mg propofol was injected. Data on age, gender, vital signs, satisfaction of the endoscopist and pain intensity of the patients were recorded using a numerical rating scale. The data were analyzed using the chi -square test and t-test and SPSS software, with a P˂0.05 value considered significant.
Results: The two groups were similar in terms of age (P=0.64) and gender (P=0.055).The mean pain score in the oxycodone group was 3.22±1.78 and in the fentanyl group 2.00±1.43 (P= 0.001). The need for a propofol rescue dose during colonoscopy was higher in the oxycodone group than in the fentanyl group (P= 0.56). There were no significant differences between the two groups in terms of heart rate, respiratory rateand colonoscopist satisfaction (P>0.05).
Conclusion: Considering that oral oxycodone has a good analgesic effect compared to intravenous fentanyl, this drug can be used as an analgesic for patients undergoing colonoscopy.

(Clinical Trials Registry Number: IRCT20181216041991N1)