Journal of Anesthesiology and Pain

Background &aim: Several reasons cause to pain in ICU patients. The pain brings some side effects in the patients so that different methods have been introduced for pain reduction. The aim of this study was comparison the effect of epidural fentanyl injection with intravenous fentanyl injection for analgesia and the effect of these two methods on ICU patients' continuousness level.
Material and methods: This investigation was a single-blind clinical trial in ICU patients of Shahid Bahonar Hospital in Kerman. These patients suffered from abdominal and chest trauma that were mechanically ventilated. Sixty patients were assessed in two groups. Patients in Group A received intravenous fentanyl for first 24 hrs, and then get epidural fentanyl from epidural catheter. Patients in B group were injected by epidural fentanyl in first 24 hrs, and then by intravenous fentanyl in second 24 hrs. Levels of fentanyl were 1.5 mcg.kg^-1 intravenous injection and 8 mcg.kg^-1 for epidural injection that were regulated with injection pump. Glascow Coma Scale and Visual Analogue Pain Score were assessed in 0, 2, 6, 24, 50, 54 and 72 hours.
Results: In both groups, pain score in 2 hours was significantly lower in intravenous injection than epidural way but after 6 hours, epidural way cause to relieve pain than intravenous way (P<0.05). In all items, fentanyl intravenous injection cause to decrease patients GCS than epidural way (P<0.05). There were no significant differences between patient's pain score and GCS with their age, sex, and trauma (abdomen, chest or both of them) (P>0.05).
Conclusion: The best way of pain control in mechanically ventilated patients with abdominal and chest trauma is intravenous injection of fentanyl in the first 2 hours and epidural injection of it in other hours. In addition, intravenous injection of fentanyl always decreases consciousness level more than epidural way.