• Minerva anestesiologica · Jun 2003

    Randomized Controlled Trial Comparative Study Clinical Trial

    Postoperative analgesia after preincisional administration of remifentanil.

    • K Gerlach, T Uhlig, M Hppe, T Khirt, L Saager, and P Schmucker.
    • Department of Anaesthesiology, Schleswig-Holstein University Hospital, Campus Lbeck, Lübeck, Germany. klaus.gerlach@medinf.mu-lubeck.de
    • Minerva Anestesiol. 2003 Jun 1;69(6):563-9, 569-73.

    AimThe aim of this study was to assess postoperative analgesia after preincisional and postincisional administration of remifentanil.MethodsRandomized trial, 24 hours.SettingUniversity hospital, hospitalized care.Patients48 adult patients scheduled for lumbar vertebral surgery.Interventionsin group R5, patients received an infusion of 0.2 microg kg(-1) min(-1) remifentanil over 5 minutes, followed by a break of 15 minutes before anesthesia was started. Anesthesia was induced by infusion of 0.25 microg kg(-1) min(-1) remifentanil and a bolus of 1.5 microg kg(-1) propofol, followed by a continuous infusion of 2 to 3 microg kg(-1) h-1 propofol and 0.25 microg kg(-1) min(-1) remifentanil until end of anesthesia. In group R20, patients received 0.05 microg kg(-1) min(-1) remifentanil over 20 minutes before the induction of anesthesia. In group RL, anesthesia was induced and maintained with propofol. After surgery began, a remifentanil infusion of 0.5 microg kg(-1) min(-1) was given for 50 minutes, then reduced to 0.25 microg kg(-1) min(-1). The total remifentanil doses were similar in the 3 groups.Measurespatients used patient-controlled analgesia (piritramide) for postoperative pain management. They recorded pain on a numeric rating scale every half hour.StatisticsKruskal-Wallis test, pairwise Mann-Withney U-test, orthogonal polynomials (pain scores).ResultsPATIENTS given postincisional remifentanil (RL) had the slowest decrease in postoperative pain scores (p<0.01) and the highest cumulative piritramide consumption (p<0.08).ConclusionThe preincisional administration of remifentanil followed by a continuous infusion of 0.25 microg kg(-1) min(-1) appears to reduce pain scores and piritramid consumption when compared with a postincisional regimen.

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