Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-10T16:44:57.225Z Has data issue: false hasContentIssue false
  • English
  • Français

Pain control with low-dose alfentanil in children undergoing minor abdominal and genito-urinary surgery

Published online by Cambridge University Press:  23 December 2004

F. Leoni ,
F. Benni ,
T. Iacobucci  and
G. de Francisci
F. Leoni
Affiliation:
Catholic University of Sacred Heart, Istituto di Anestesiologia e Rianimazione, Rome, Italy
F. Benni
Affiliation:
Catholic University of Sacred Heart, Istituto di Anestesiologia e Rianimazione, Rome, Italy
T. Iacobucci
Affiliation:
Catholic University of Sacred Heart, Istituto di Anestesiologia e Rianimazione, Rome, Italy
G. de Francisci
Affiliation:
Catholic University of Sacred Heart, Istituto di Anestesiologia e Rianimazione, Rome, Italy
Get access

Abstract

Summary

Background and objective: The aim of this study was to investigate the quality of intra- and postoperative analgesia obtained by alfentanil compared to that produced by peripheral blockade in children.

Methods: During sevoflurane-nitrous oxide atracurium anaesthesia for minor abdominal or genito-urinary surgery, three groups of children aged 0–8 yr received 25 μg kg−1 alfentanil intravenously (n = 28), or peripheral nerve blockade using 1 mL−1 ropivacaine 0.475% (n = 24), or 12.5 μg kg−1 alfentanil intravenously with peripheral nerve blockade using 1 mL kg−1 ropivacaine 0.475% (n = 30). Changes in blood pressure and heart rate were measured during the procedures. Postoperative pain was assessed using the face, legs, activity, cry, consolability (FLACC) observational tool for quantifying pain behaviour and a numerical scale scored by nurses, doctors, parents and children.

Results: There was no significant difference in intra- or postoperative analgesic efficacy among the three groups. Patients who received alfentanil had significantly lower heart rates than those who received nerve blockade only (96.0 ± 15.6 vs. 115.9 ± 23.2 beats min−1, P < 0.001). FLACC and numerical scale scores did not differ among the groups. There were no significant differences in incidence of vomiting or use of pain medications.

Conclusions: It was concluded that a low-dose, intravenous bolus of alfentanil may be an efficient alternative to peripheral nerve blockade in controlling pain during and after minor abdominal and genito-urinary surgery.

Keywords

ANAESTHESIA, anaesthesia local, anaesthesia generalPAEDIATRICS ANALGESICS, OPIOID, alfentanilANAESTHETICS, LOCAL, ropivacainePAIN, POSTOPERATIVE
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 9 , September 2004 , pp. 738 - 742
Copyright
2004 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aun CS. New i.v. agents. Br J Anaesth 1999; 83: 29–41.Google Scholar
Sfez M, Le Mapihan Y, Gaillard JL, Rosemblatt JM. Analgesia for appendectomy: comparison of fentanyl and alfentanil in children. Acta Anaesthesiol Scand 1990; 34: 30–34.Google Scholar
Mulroy JJ Jr, Davis PJ, Rymer DB, et al. Safety and efficacy of alfentanil and halothane in paediatric surgical patients. Can J Anaesth 1991; 38: 445–449.Google Scholar
Gronert BJ, Davis PJ, Cook DR. Continuous infusion of alfentanil in infants undergoing inguinal herniorraphy. Paediatric Anaesth 1992; 2: 105–110.Google Scholar
Orfei P, Bigetti E, Patrizio A, Pinto G. The use of alfentanil for short duration surgery in pediatric anesthesia. Minerva Anestesiol 2000; 66: 123–129.Google Scholar
Scheller MS, Zornow MH, Saidman LJ. Tracheal intubation without the use of muscle relaxants: a technique using propofol and varying doses of alfentanil. Anesth Analg 1992; 75: 788–793.Google Scholar
Beck GN, Masterson GR, Richards J, et al. Comparison of intubation following propofol and alfentanil with intubation following thiopentone and suxamethonium. Anaesthesia 1993; 48: 876–880.Google Scholar
Hiller A, Klemola UM, Saarnivaara L. Tracheal intubation after induction of anaesthesia with propofol, alfentanil and lidocaine without neuromuscular block in children. Acta Anaesthesiol Scand 1993; 37: 725–729.Google Scholar
McConaghy P, Bunting HE. Assessment of intubating conditions in children after induction with propofol and varying doses of alfentanil. Br J Anaesth 1994; 73: 596–599.Google Scholar
Robinson DN, O’Brien K, Kumar R, Morton NS. Tracheal intubation without neuromuscular blockade in children: a comparison of propofol combined either with alfentanil or remifentanil. Paediatr Anaesth 1998; 8: 467–471.Google Scholar
Blair JM, Hill DA, Bali IM, Fee JP. Tracheal intubating conditions after induction with sevoflurane 8% in children. A comparison with two intravenous techniques. Anaesthesia 2000; 55: 774–778.Google Scholar
Ng KP, Wang CY. Alfentanil for intubation under halothane anaesthesia in children. Paediatr Anaesth 1999; 9: 491–494.Google Scholar
Merkel SI, Voepel-Lewis T, Shayevitz JR, Malviya S. The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nurs 1997; 23: 293–297.Google Scholar
Annila P, Viitanen H, Reinikainen P, Baert G, Lindgren L. Induction characteristics of thiopentone/suxamethonium, propofol/alfentanil or halothane alone in children aged 1–3 years. Eur J Anaesth 1999; 16: 359–366.Google Scholar
Hiller A, Saarnivaara L. Injection pain, cardiovascular changes and recovery following induction of anaesthesia with propofol in combination with alfentanil or lignocaine in children. Acta Anaesthesiol Scand 1992; 36: 564–568.Google Scholar
Martineau RJ, Tousignant CP, Miller DR, Hull KA. Alfentanil controls the haemodynamic response during rapid-sequence induction of anaesthesia. Can J Anaesth 1990; 37: 755–761.Google Scholar
White PF, Coe V, Shafer A, Sung ML. Comparison of alfentanil with fentanyl for outpatient anesthesia. Anesthesiology 1986; 64: 99–106.Google Scholar
Davis PJ, Chopyk JB, Nazif M, Cook DR. Continuous alfentanil infusion in pediatric patients undergoing general anesthesia for complete oral restoration. J Clin Anesth 1991; 3: 125–130.Google Scholar
Patel RI, Hannallah RS. Anesthetic complications following pediatric ambulatory surgery: a 3-yr study. Anesthesiology 1988; 69: 1009–1012.Google Scholar
Sternlo JE, Sandin RH. Recurrent respiratory depression after total intravenous anaesthesia with propofol and alfentanil. Anaesthesia 1998; 53: 378–381.Google Scholar
den Hollander JM, Hennis PJ, Burm AG, Bovill JG. Alfentanil in infants and children with congenital heart defects. J Cardiothorac Anesth 1988; 2: 12–17.Google Scholar