Key result
Intrathecal fentanyl is a valuable opioid analgesic in anaesthesia and pain management, though it is associated with side effects such as pruritus, respiratory depression, urinary retention, and hypotension.
This review highlights the pharmacological and clinical profile of intrathecal fentanyl as a valuable adjuvant in anaesthesia for prolonging post-operative analgesia.
Supports cautious intrathecal fentanyl use with side-effect monitoring; leaves open need for RCTs to optimize dosing and alternatives.
Fentanyl is an opioid with multiple routes of administration, including intrathecal administration. The intrathecal use of fentanyl was started in the 1970s and is currently utilised in combination with general anaesthesia or as an adjuvant to local anaesthesia in prolonging the duration of analgesia and providing more effective post-operative analgesia. It exerts its action via mu receptors in the spinal cord and its analgesic effects by reducing the release of excitatory nociceptive neurotransmitters, gamma-aminobutyric acid, and glycine. Intrathecal fentanyl is used in various clinical settings, including perioperative pain management, day case surgery, obstetric practice (e.g., caesarean section), gynaecological surgeries, and major joint replacement surgeries. Specific side effects are associated with using intrathecal fentanyl. These include pruritus, respiratory depression, urinary retention, and hypotension. Amongst these side effects, pruritus is most commonly encountered. Intrathecal fentanyl has a comprehensive pharmacological and clinical profile, the understanding of which makes it a valuable opioid analgesic in anaesthesia and pain management.
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Bhuyan et al. (2024) conducted a review in Perioperative pain. Intrathecal fentanyl was evaluated. Intrathecal fentanyl is a valuable opioid analgesic in anaesthesia and pain management, though it is associated with side effects such as pruritus, respiratory depression, urinary retention, and hypotension.
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