Comparative Study of Intravenous Fentanyl Vs Nebulisation Fentanyl for Postoperative Analgesia in Patients Undergoing Lower Limb Surgeries - A Randomised Controlled Study

Introduction: Intravenous administration of Fentanyl is the gold standard treatment for the relief of post-operative pain. Fentanyl being a highly lipophilic drug, pulmonary route of administration provided promising results. Additionally, it is non-invasive, and slow in onset of action. It reaches a therapeutic concentration in less than 2 minutes. Methodology: This is a Prospective randomized controlled trail, among the 60 patients of ASA 1 or 2, admitted for lower limb surgeries randomly divided in two groups with 30 patients in each group. Nebulisation Fentanyl group-4 microg/kg of fentanyl and IV Fentanyl group-2microg/kg were compared for hemodynamic stability, onset and duration of analgesia, Sedation and complications. Results: Baseline characteristics such as Age, Weight and Gender were not significantly different between the groups. Haemodynamic Parameters such as Heart rate, SpO2, respiratory rate, and Systolic, Diastolic and Mean arterial Blood Pressure at baseline were similar. IV fentanyl group produced a slight significant change in hemodynamic parameters such as Heart rate, respiratory rate, and SystolicBlood Pressure. The pain score was significantly lower among the IV fentanyl group compared to the Neb. Fentanyl group and after 15 min post op, the pain score was significantly lower among the Neb. Fentanyl group compared to IV fentanyl group. The Duration of Rescue Analgesia (min) among Neb. Fentanyl group was significantly longer. IV Fentanyl group had significantly higher Nausea / Vomiting. Pruritis and respiratory depression were not significantly different. Conclusion: Administration of Fentanyl via nebulisation can be preferred, over the intravenous administration for its better hemodynamic stability, longer duration of analgesia, without complications. Intravenous administration of Fentanyl can be considered where rapid onset and sedation are needed.