European Society of Anaesthesiologists; 8th Annual Meeting with the Austrian International Congress; Vienna, Austria, 1-4 April 2000
Background and goal of study: We have previously reported the preliminary results of our study on remifentanil vs. fentanyl in i.v. anaesthesia for lumbar spine surgery . Here, we report the final results of the study.
Materials and methods: Sixty patients (age below 65 years, ASA I or II, body mass index below 27) were admitted to the study. Thirty patients were assigned to the remifentanil group (RG) and 30 to the fentanyl group (FG). The induction of anaesthesia was obtained with thiopental (4-6 mg kg−1), droperidol (2.6 mg), vecuronium (0.08-1 mg kg−1); anaesthesia was maintained using N2O 60%. A blind continuous infusion of the opioids was obtained using three different syringes for induction, maintenance and end of anaesthesia; each of them contained different concentrations of remifentanil or fentanyl, in order to get the appropriate infusion rates using the same infusion speed . After the operation all patients were administered ketorolac (30 mg at the end of the operation, after 4 and 12 hours).
Blood pressure, heart rate, end-tidal CO2 and pulse oximetry were monitored throughout the operation. The wake-up time was checked using the Aldrete Scale; incidence of nausea, vomiting and shivering were monitored at the end of operation; postoperative pain (using the Visual Analogue Scale, VAS) was monitored as well for 2 hours after the end of operation.
Results and discussion: No significant differences in the duration of anaesthesia were found in the two groups. The systolic arterial pressure (SAP) was significantly higher in FG during intubation (135 ± 16 vs. 124 ± 24; P<0.05); both SAP and diastolic arterial pressure (DAP) were significantly higher in FG during skin incision (127 ± 15 vs. 116 ± 16 and 76 ± 11 vs. 70 ± 13; P < 0.05), retractor positioning (128 ± 17 vs. 116 ± 13, respectively; P < 0.01) and disk removal (131 ± 22 vs. 118 ± 17 and 75 ± 11 vs. 7 ± 8, respectively; P < 0.05). The recovery from anaesthesia, as defined by Aldrete Scale, was slightly shorter in RG, but the difference between FG and RG was not significant. Postoperative pain was higher in GF than in FG (VAS=4 vs. 2.9; P<0.05) 10 min after the end of the operation, but no significant differences were found later. No significant differences in the incidence of nausea or vomiting were found in the two groups, while RG showed a higher incidence of shivering (60% vs. 21% of cases; P<0.01).
Conclusions: Our results confirm that remifentanil may be an effective alternative to fentanyl in lumbar spine surgery. The doses used in this study yielded similar results with regard to wake-up time; remifentanil assured a better haemodynamic stability, but was affected by a higher incidence of shivering.
1 Facco E et al. BJA
1999; 82 (Suppl. 1):
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