Efficacy of addition of fentanyl to epidural bupivacaine on postoperative analgesia after thoracotomy for lung resection in infants

Anesthesiology. 2008 Nov;109(5):890-4. doi: 10.1097/ALN.0b013e31818aa6cb.


Background: The authors evaluated the efficacy of adding fentanyl to epidural bupivacaine in infants up to 6 months of age after a thoracotomy in a prospective, randomized, double-blind study. The primary outcome was the total amount of rescue doses of intravenous nalbuphine in the first 24 h after surgery. Secondary outcomes included (1) time to first rescue dose of nalbuphine, (2) pain scores, and (3) behavior scores.

Methods: Thirty-two infants were randomly assigned to receive an epidural infusion containing 0.1% bupivacaine (group B; n = 16) or 0.1% bupivacaine and 2 microg/ml fentanyl (group BF; n = 16). Patients were evaluated up to 24 h after surgery for pain; amount of analgesic rescues and time to first rescue; pain scores; behavior scores (five-item behavior score); and complications, including respiratory depression, oxygen requirement, vomiting, and urinary retention.

Results: The two groups had similar demographics. Nalbuphine consumption (P = 0.001) and pain scores (P < 0.001) in the first 24 h were significantly decreased in group BF compared with group B. The time to first analgesic rescue was significantly longer in group BF (P = 0.005). The five-item behavior score was significantly better in group BF than in group B (P = 0.01). The incidence of side effects, the time to first successful feeding, and the time to discharge were similar in both groups.

Conclusions: Addition of 2 microg/ml epidural fentanyl to 0.1% bupivacaine results in improved postthoracotomy analgesia without any increase in side effects, compared with 0.1% bupivacaine, in infants up to 6 months of age.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Analgesia, Epidural / methods*
  • Bupivacaine / administration & dosage*
  • Double-Blind Method
  • Drug Therapy, Combination
  • Female
  • Fentanyl / administration & dosage*
  • Humans
  • Infant
  • Infant, Newborn
  • Lung / drug effects
  • Lung / pathology
  • Lung / surgery*
  • Male
  • Pain Measurement / drug effects
  • Pain Measurement / methods
  • Pain, Postoperative / drug therapy*
  • Pain, Postoperative / etiology
  • Prospective Studies
  • Thoracotomy* / adverse effects


  • Fentanyl
  • Bupivacaine