Evaluation of the Effect of Pheniramine Maleate on Fentanyl-induced Cough (FIC) in Opium Addicts

Abstract

Background: Fentanyl is a synthetic opioid used to induce anesthesia. Intravenous bolus injection can cause coughing during induction of anesthesia and intracranial, intraocular, and intra-abdominal hypertension. This cough is often temporary and self-limiting, but can be harmful in some patients. pheniramine maleate is a first-generation antihistamine that is used to control allergies. Thus, this study evaluated the effect of pheniramine maleate on this type of cough in opium addicts.

Material and Methods: This randomized, double-blind clinical trial was performed on opium addicts admitted to Imam Reza Hospital in Mashhad, Iran in 2019. After obtaining informed consent, opium addicts who underwent elective surgery for more than half an hour were divided into two groups. Patients were routinely monitored. Serum infusion was started for all patients. In the control group, 2 ml of normal saline 0.9% and in the patient group, 2-3 ml of pheniramine maleate iv bolus was injected. After 90 seconds, fentanyl was injected for 3 seconds at a dose of 2 µ/kg to induce anesthesia. 90 seconds after fentanyl injection, cough intensity was divided into three groups including mild (1 to 2), moderate (3 to 5) and severe (more than 5) depending on the number of coughs observed and vital signs parameters were recorded. Induction of anesthesia was completed with propofol and atracurium. All data were analyzed using Spss software version 23.

Results: In the evaluation of 86 opioid patients who underwent elective surgery, it was observed that 7 patients (16.3%) and 1 patient (2.3%) had coughs in the control and intervention groups, respectively. This difference was statistically significant (P = 0.029). Additionally, cough severity was mild in 4 patients (9.3%) in the control group, followed by moderate (2 patients, 4.7%) and severe (1 patient, 2.3%). In the intervention group, the severity of cough in a person was only mild, which this difference was statistically significant (P = 0.025). In the control group, the duration of cough in patients (7 patients) who had a cough was 5.7 ± 3.1 seconds, while this amount was 4 seconds for a person in the intervention group, which this difference was statistically significant (P = 0.026).

Conclusion: Pheniramine maleate reduces the incidence and duration of fentanyl-induced cough in opium-addicted patients, therefore, it can be used to improve the condition of fentanyl-induced cough in patients with opium addiction.