Evaluation of the effect of nasal fentanyl in comparison with intravenousfentanyl in cataract surgery by phacoemulsification method

Background: The risk of anesthesia increases with age, so it is necessary to choose asafe and effective method. In this study, we compared the effectiveness of intranasalfentanyl with intravenous fentanyl in patients undergoing cataract surgery.Methods: This study was a triple-blind prospective randomized clinical trial (Thepatient, physician, and data analyzer were unaware of the patient grouping). The studywas performed from April ۲۰۱۷ to March ۲۰۱۹ in Feyz Hospital, Isfahan, Iran. ۹۰patients over ۱۸ years of age who were candidates for cataract surgery were included inthe study and were divided in two groups receiving intravenous fentanyl (IVF) orintranasal fentanyl (INF). The dose of fentanyl in both groups was ۱.۵ μg/kg with amaximum of ۱۰۰ μg. In the IVF group, ۱ ml of normal saline was dripped into eachnasal passage ۱۰ minutes before surgery and intravenously fentanyl was injected ۲minutes before surgery. In the INF group, ۱ ml of fentanyl was administered into eachnostril ۱۰ minutes before surgery and ۲ ml of saline was administered intravenouslytwo minutes before surgery.Results: In this study, there was no significant difference between the two groups interms of mean heart rate (P=۰.۷۶۲), mean arterial blood oxygen saturation (P=۰.۲۶۲),mean systolic blood pressure (P=۰.۲۶۴), mean arterial blood pressure (۰.۴۶۲),satisfaction rate Patient (P=۰.۲۳۱), duration of surgery (P=۰.۶۱۲) and pain intensity(P=۰.۸۷). But in the intravenous fentanyl group (IVF), the level of sedation (P=۰.۰۰۲)and the level of surgeon satisfaction (P<۰.۰۰۱) were higher than intranasal fentanylgroup (INF). There was no significant difference between the two groups in terms ofside effects (P=۰.۱۷۱) and surgery time (P=۰.۶۱۲). The mean VAS was notsignificantly different between the two groups.Conclusion: The study showed that intranasal administration of fentanyl comparedwith intravenous administration of fentanyl provided similar sedation andcardiovascular response. Intranasal administration of fentanyl is a non-invasive, safeand effective method, that is easy to use and can be a viable alternative to intravenous administration.

Keywords:

cataract , fentanyl , intranasal , intravenous , phacoemulsification