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Remifentanil compared with morphine for postoperative patient-controlled analgesia after major abdominal surgery: a randomized controlled trial

Published online by Cambridge University Press:  11 May 2005

F. Kucukemre ,
N. Kunt ,
K. Kaygusuz ,
F. Kiliccioglu ,
B. Gurelik  and
A. Cetin
F. Kucukemre
Affiliation:
Eskisehir State Hospital, Department of Anaesthesiology, Eskisehir, Turkey
N. Kunt
Affiliation:
Cumhuriyet University School of Medicine, Department of Anaesthesiology, Sivas, Turkey
K. Kaygusuz
Affiliation:
Cumhuriyet University School of Medicine, Department of Anaesthesiology, Sivas, Turkey
F. Kiliccioglu
Affiliation:
Cumhuriyet University School of Medicine, Department of Anaesthesiology, Sivas, Turkey
B. Gurelik
Affiliation:
Cumhuriyet University School of Medicine, Department of Anaesthesiology, Sivas, Turkey
A. Cetin
Affiliation:
Cumhuriyet University School of Medicine, Department of Obstetrics and Gynaecology, Sivas, Turkey
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Extract

Summary

Background and objective: This randomized, double-blinded clinical study was designed to compare the efficacy and safety of remifentanil and morphine administered using intravenous (i.v.) patient-controlled analgesia (PCA) for postoperative analgesia after major abdominal surgery during the first 24 postoperative hours.

Methods: Sixty-nine patients were randomly allocated into two groups, each receiving remifentanil or morphine. The first group received i.v. remifentanil PCA with a loading dose of 45 μg, a maintenance dose of 1 μg min−1, a bolus dose of 15 μg and a lockout interval of 10 min during the first 24 postoperative hours. The second group received i.v. morphine PCA with a loading dose of 5 mg, a maintenance dose of 0.3 mg h−1, a bolus dose of 1 mg and a lockout interval of 15 min. Age, weight, sex, history of general anaesthesia, duration of surgery and time spent in the post-anaesthesia care unit were recorded. Preoperative pulse rate, systolic and diastolic blood pressures (BP), respiration rate and arterial blood gases were collected. Pulmonary function was tested before induction of anaesthesia, as well as at 4 and 26 h after operation. Pulse rate, systolic and diastolic BP, respiration rate, arterial blood gases, sedation and visual analogue scores, and presence of side-effects in the recovery room and on the ward for 24 h were recorded at 0, 1, 2, 4, 6, 12, 18 and 24 h after operation. Total drug use, number of boluses delivered, number of boluses demanded and delivery/demand ratio were collected.

Results: Sixty patients were evaluated. The groups did not differ in age, weight, sex, history of general anaesthesia, duration of surgery or time spent in the recovery unit. There were also no clinically relevant differences between the groups with regard to haemodynamic and respiratory parameters as well as sedation and visual analogue scores (P > 0.05). More bolus doses were demanded and delivered and the delivery/demand ratio was significantly higher in the remifentanil group (P < 0.05). There was no finding suggesting acute opioid tolerance during remifentanil or morphine PCA.

Conclusion: The i.v. remifentanil PCA with the chosen dosage regimen after abdominal surgery produces postoperative analgesia and has cardiovascular side-effects similar to those achieved with i.v. morphine. Special attention must be given to respiratory depression during establishment of PCA with remifentanil.

Keywords

ANALGESIA, patient-controlledANALGESICS, remifentanilANALGESICS, OPIOID, morphinePAIN, postoperativeSURGERY, abdominal
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 5 , May 2005 , pp. 378 - 385
Copyright
© 2005 European Society of Anaesthesiology

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References

Walder B, Schafer M, Henzi I, Tramer MR. Efficacy and safety of patient-controlled opioid analgesia for acute postoperative pain: a quantitative systematic review. Acta Anaesthesiol Scand 2001; 45: 795–804.Google Scholar
Unlugenc H, Ozalevli M, Guler T, Isik G. Postoperative pain management with intravenous patient-controlled morphine: comparison of the effect of adding magnesium or ketamine. Eur J Anaesthesiol 2003; 20: 416–421.Google Scholar
Lehmann KA. New developments in patient-controlled postoperative analgesia. Ann Med 1995; 27: 271–282.Google Scholar
Owen H, Plummer J. Patient-controlled analgesia: current concepts in acute pain management. CNS Drugs 1997; 8: 203–218.Google Scholar
Etches RC. Patient-controlled analgesia. Surg Clin North Am 1999; 79: 297–312.Google Scholar
Feldman PL, James MK, Brackeen MF, et al. Design, synthesis and pharmacological evaluation of ultrashort- to long-acting opioid analgesics. J Med Chem 1991; 34: 2202–2208.Google Scholar
James MK. Remifentanil and anesthesia for the future. Exp Opin Invest Drugs 1994; 3: 331–340.Google Scholar
Glass PSA, Hardman D, Kamiyama Y, et al. Preliminary pharmacokinetics and pharmacodynamics of an ultra-short-acting opioid: remifentanil (G187084B). Anesth Analg 1993; 77: 1031–1040.Google Scholar
Kapila A, Glass PSA, Jacobs JR, et al. Measured context-sensitive half-times of remifentanil and alfentanil. Anesthesiology 1995; 83: 968–975.Google Scholar
Davis PJ, Stiller RL, Wilson AS, et al. In vitro remifentanil metabolism: the effects of whole blood constituents and plasma butyrylcholinesterase. Anesth Analg 2002; 95: 1305–1307.Google Scholar
Ramsay MA, Savage TM, Simpson BR, Goodwin R. Controlled sedation with alphaxalone-alphadolone. Br Med J 1974; 2: 656–659.Google Scholar
Wrench IJ, Cavill G, Ward JEH, Crossley AWA. Comparison between alfentanil, pethidine and placebo in the treatment of postanesthetic shivering. Br J Anaesth 1997; 79: 541–542.Google Scholar
Hunt R, Fazekas B, Thorne D, Brooksbank M. A comparison of subcutaneous morphine and fentanyl in hospice cancer patients. J Pain Symptom Manage 1999; 18: 111–119.Google Scholar
Yarmush J, D'Angelo R, Kirkhart B, et al. A comparison of remifentanil and morphine sulfate for acute postoperative analgesia after total intravenous anesthesia with remifentanil and propofol. Anesthesiology 1997; 87: 235–243.Google Scholar
Ramsay MA, Macaluso A, Tillmann Hein HA, Cancemi E. Use of remifentanil in patients breathing spontaneously during monitored anesthesia care and in the management of acute postoperative care. Anesthesiology 1998; 88: 1124–1126.Google Scholar
Servin FS. Remifentanil: an update. Curr Opin Anaesthesiol 2003; 16: 367–372.Google Scholar
Gardmark M, Ekblom M, Bouw R, Hammarlund-Udenaes M. Quantification of effect delay and acute tolerance development to morphine in the rat. J Pharmacol Exp Ther 1993; 267: 1061–1067.Google Scholar
Kissin I, Bright CA, Bradley Jr EL. The effect of ketamine on opioid-induced acute tolerance: can it explain reduction of opioids consumption with ketamine-opioid analgesic combinations? Anesth Analg 2000; 91: 1483–1488.Google Scholar
Hayashida M, Fukunaga A, Hanaoka K. Detection of acute tolerance to the analgesic and nonanalgesic effects of remifentanil infusion in a rabbit model. Anesth Analg 2003; 97: 1347–1352.Google Scholar
Guignard B, Bossard AE, Coste C, et al. Acute opioid tolerance: intraoperative remifentanil increases postoperative pain and morphine requirement. Anesthesiology 2000; 93: 409–417.Google Scholar
Vinik HR, Kissin I. Rapid development of tolerance to analgesia during remifentanil infusion in humans. Anesth Analg 1998; 86: 1307–1311.Google Scholar
Schraag S, Checketts MR, Kenny GN. Lack of rapid development of opioid tolerance during alfentanil and remifentanil infusions for postoperative pain. Anesth Analg 1999; 89: 753–757.Google Scholar
Cortinez LI, Brandes V, Munoz HR, Guerrero ME, Mur M. No clinical evidence of acute opioid tolerance after remifentanil-based anaesthesia. Br J Anaesth 2001; 87: 866–869.Google Scholar
Gustorff B, Nahlik G, Hoerauf KH, Kress HG. The absence of acute tolerance during remifentanil infusion in volunteers. Anesth Analg 2002; 94: 1223–1228.Google Scholar
Thurlow JA, Laxton CH, Dick A, et al. Remifentanil by patient-controlled analgesia compared with intramuscular meperidine for pain relief in labour. Br J Anaesth 2002; 88: 374–378.Google Scholar
Dill-Russell PC, Ng L, Ravalia A. Use of a remifentanil PCA for a patient with multiple rib fractures. Can J Anaesth 2002; 49: 757.Google Scholar
Volmanen P, Akural EI, Raudaskoski T, Alahuhta S. Remifentanil in obstetric analgesia: a dose-finding study. Anesth Analg 2002; 94: 913–917.Google Scholar
Baxter AD. Respiratory depression with patient-controlled analgesia (Editorial). Can J Anaesth 1994; 41: 87–90.Google Scholar
Parker RK, Holtmann B, White PF. Patient-controlled analgesia: does a concurrent opioid infusion improve pain management after surgery? JAMA 1991; 266: 1947–1952.Google Scholar
Russell AW, Owen H, Ilsley AH, et al. Background infusion with patient-controlled analgesia: effect on postoperative oxyhaemoglobin saturation and pain control. Anaesth Intens Care 1993; 21: 174–179.Google Scholar
Dawson PJ, Libreri FC, Jones DJ, et al. The efficacy of adding a continuous intravenous morphine infusion to patient-controlled analgesia (PCA) in abdominal surgery. Anaesth Intens Care 1995; 23: 453–458.Google Scholar