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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Intraoperative Opioids for Thoracic Surgery: Impact of Remifentanil and Fentanyl on Post-operative Pain Control and Morphine Consumption

Background: Remifentanil could be the opioid of choice in fast track surgery for the unique pharmacokinetic properties of fast onset time of action, a predictable and rapid recovery and facilitation of early extubation. According to the literature, intraoperative use of remifentanil may be associated with postoperative hyperalgesia and increased postoperative opioid consumption, in particular when administered in high doses. For this reason, we decided to investigated the post-operative pain and the total use of opioids in resective lung operation in fast track surgery independently of intraoperative opioid (fentanyl or remifentanil), local regional anesthesia (intercostal, nerve block, paravertebral nerve block, wound infiltration) and the management of post-operative pain (morphine elastomer or Patient Controlled Analgesia).

Keywords: morphine consumption, pain control, remifentanil.

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Comparison of remifentanil versus fentanyl general anesthesia for short outpatient urologic procedures

Abstract

Study objectives. To compare the effect of remifentanil versus fentanyl isoflurane general anesthesia on Aldrete score, emergence, extubation and discharge times from the operating room (OR) and postanesthesia care unit (PACU) following short outpatient urologic procedures (panendoscopy and cystoscopy, bladder hydrodilatation, stent placement).

Patients and methods. 40 patients 18 years of age or older scheduled for short elective outpatient urological procedures with an expected duration of less than 30 minutes.

Following Institutional Review Board (IRB) approval and written informed consent, 40 American Society of Anesthesiologists (ASA) physical class 1-3 adult outpatients were enrolled and equally (n=20) randomized into remifentanil and fentanyl groups. Preoperatively, all subjects received intravenous (IV) midazolam 1-2 mg and were induced with propofol 2 mg/kg IV. Muscle relaxation was achieved with succinylcholine or rocuronium, followed by intubation. The remifentanil group received remifentanil 1 g/kg IV at induction with a maintenance dose of remifentanil 0.1 to 2 g/kg/min IV in the presence of 60% nitrous oxide (N2O)/40% oxygen (O2) and end-tidal isoflurane of 0.3 to 0.4% (for amnesia). The fentanyl group received fentanyl 2 g/kg IV at induction, maintenance dose of fentanyl 2 to 3 g/kg IV intermittent bolus, and 60% N2O/40% O2 with 2% end-tidal isoflurane. Muscle relaxation was reversed at the end of anesthesia as needed. Times for OR entry, emergence, extubation, total OR time (entry to exit) and PACU discharge time, as well as Aldrete scores at time of OR exit and PACU discharge were determined. Data was evaluated by ANOVA, t-test and Mann-Whitney tests. A p

Results. There was no significant difference between groups in age, gender, weight, ASA class, PACU analgesic or antiemetic use, or times of emergence, extubation, OR exit and PACU discharge. There was a significant difference (p<0.05) in OR exit Aldrete score but not PACU discharge Aldrete score. No adverse events were noted.

Conclusions. While there was no difference between the remifentanil and fentanyl groups regarding recovery time from OR and PACU, remifentanil patients had significantly better OR exit Aldrete scores with less sedation upon arrival at phase I PACU recovery than the fentanyl group. This anesthesia technique may prove helpful for fast-track eligibility of these patients.

Key words: remifentanil, fentanyl, isoflurane, general anesthesia, urologic procedures, outpatient surgery, Aldrete score, recovery time, discharge time

 

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