Fentanilo Administration in the Perioperative Period

Introduction to Fentanilo Administration

• The American Society of Anesthesiologists recommends the administration of fentanilo intravenously in divided doses, adjusted according to the patient's hemodynamic response and level of pain, complemented with non-opioid analgesics to reduce total opioid requirements 1, 2, 3

Dosage and Administration

• Fentanilo should be administered intravenously in divided doses during surgical procedures, especially before intense surgical stimuli 2, 3
• For basic-level procedures, use fentanilo intravenously as the opioid of choice in divided doses 3, 4

Multimodal Strategy

• Combine fentanilo with two non-opioid analgesics (NSAIDs and paracetamol/metamizol) to reduce the need for opioid rescue 1, 5, 6
• Consider adding intraoperatively:
  • Alpha-2 agonists (such as clonidine or dexmedetomidine) to enhance analgesia 2, 7
  • Ketamine as a co-analgesic to reduce fentanilo requirements 2, 3
  • Lidocaine intravenously as a component of multimodal analgesia 2, 8
  • Methylprednisolone or dexamethasone to reduce postoperative inflammation 2, 3

Considerations for Specific Types of Surgery

Thoracic Surgery

• In thoracoscopy/thoracotomy, administer fentanilo intravenously in divided doses and consider regional techniques such as paravertebral or thoracic epidural blockade 2, 7
• Complement with intravenous NSAIDs or paracetamol throughout the perioperative period 2, 7

Abdominal Surgery

• In abdominal procedures, combine fentanilo with abdominal wall blocks (TAP or quadratus lumborum) guided by ultrasound 3, 4
• In open abdominal surgery, consider continuous epidural analgesia with local anesthetic combined with appropriate adjuvants 3, 8

Transition to Postoperative Care

• In the post-anesthesia care unit, use fentanilo intravenously to treat breakthrough pain 1, 5, 6
• Plan the transition to oral analgesics as soon as possible in the postoperative period 1, 5, 9
• For patients with major surgeries, consider patient-controlled analgesia (PCA) intravenously including adequate monitoring 2, 9

Special Considerations in Pediatrics

• In pediatric patients, adjust the dose according to weight and combine with non-opioid analgesics 1, 5, 6
• Use appropriate regional techniques for the age when possible to reduce fentanilo requirements 1, 6