Efficancy of intravenous fentanyl in alleviating pain during spinal needle insertion

Background: Spinal puncture is painful procedure which may cause patient refusal of spinal anesthesia in future surgery. It could be minimized with topical and infiltration local anesthetic or intravenous opioid before procedure. Objective made efficacy of intravenous fentanil in alleviating pain during spinal needle insertion. Methods: Prospective, randomized study included 88 adults (33-55 ages, ASA I/II), scheduled for lower leg surgery. Patients were divided in four equal study groups: 26G Quincke spinal needle with 20G introducer was inserted alone, three minutes after local anesthetic infiltration (2 ml of 2% lidocaine, 25G hypodermic needle) or intravenous fentanil application (0.001 mgkg-1) and without local anesthetic, fentanil and introducer. Pain was assessed after spinal needle insertion and local anesthetic infiltration by VAS score. MAP, HR and SaO2 were recorded. Sedation was assessed by Ramsay score. Statistical analysis was performed by SPSS 11.0. Results: Spinal puncture was less painful after intravenous fentanil than local lidocaine infiltration (2.27+/-7 vs. 3.18+/-0.8)(P=0.0469). Although, the most acceptable pain score was assessed 3 min after local analgesia (1.86+/0.35), pain associated with anesthetic infiltration did not justify its use concerning the efficiency of intravenous fentanil. Pain score was similar after finally puncture procedure: with introducer followed by fentanil or LA, and without introducer, fentanil and LA (2.27+/-0.7 vs. 1.86+/-0.35 and 2.14+/-0.7 vs. or)(P=0.0868). Conclusions: Intravenous fentanil (0.001 mgkg-1) provides finally better pain score for spinal puncture (26G Quincke needle, 20G introducer) than local infiltration of 2% lidocaine. It conserves respiratory and circulatory stability and optimal sedation during surgery.