Nebulized versus intravenous fentanyl for postoperative analgesia after unilateral arthroscopic anterior cruciate ligament reconstruction surgery: a prospective, randomized, comparative trial

Objectives This study aimed to compare the effect of nebulized fentanyl with intravenous fentanyl for postoperative analgesia after unilateral arthroscopic anterior cruciate ligament reconstruction surgery. Patients and methods A total of 87 patients scheduled for unilateral arthroscopic anterior cruciate ligament reconstruction surgery under regional anesthesia were enrolled in the study and were randomly allocated into two groups. Group IV included 42 patients who received 2 μg/kg of fentanyl intravenously, and Group N included 45 patients who received 4 μg/kg of fentanyl nebulization using a standard ventimask. Both groups received the analgesic drug through either intravenously or nebulization route whenever the patient reported pain for the first time in the postanesthesia care unit that was of a score greater than 4 on the visual analog scale. Observations were made for the onset and duration of analgesia, number of patients who were not relieved of pain even 15 min after analgesia administration, level of sedation using the Ramsay sedation scale, and side effects. Results Both groups were similar in terms of demographic characteristics and duration of surgery. The onset of analgesia was significantly delayed in group N in comparison with group IV, whereas the duration of analgesia was significantly longer in group N in comparison with group IV. In group IV, the Ramsay sedation score was the maximum at 5 min. In group N, there was a slow rise in the sedation score, but it was always less than that in group IV. Side effects in group N were less compared with group IV, and the number of patients who developed bradycardia was significantly higher in group IV. Conclusion This study showed that nebulization with fentanyl is a good alternative to intravenous fentanyl for adequate postoperative pain relief with fewer side effects.