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Fast-Track/Off Pump/Prediction/Outcome

The effects of remifentanil and fentanyl on postoperative pain and recovery in fast-track open heart surgery: 060

Turan, S.1; Karadeniz, Ü.1; Soyal, Ö. B.2; Erdemli, Ö.1

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European Journal of Anaesthesiology: June 2004 - Volume 21 - Issue - p 23-24

Introduction: In this study, we compared the effectiveness of remifentanil infusion and fentanyl bolus provided by patient-controlled analgesia device, for postoperative pain and recovery after fast-track cardiac surgery.

Method: This prospectively randomized, double blinded study was made in 42 ASA II group patients, undergoing fast-track Coronary Artery Bypass Grafting (CABG) surgery. Anaesthesia was induced with sevoflurane and remifentanil. After operation, the patients were divided into two groups. In Group 1 (remifentanil group), constant continuous infusion of 0.1 μg · kg−1 · min−1 remifentanil was given by patient controlled analgesia device. In Group 2 (fentanyl group), 10 μg loading dose of fentanyl was administered 5 minutes before the end of the surgery. After fentanyl administration, we gave 0.1 μg · kg−1 fentanyl bolus doses with 8 minutes lockout time without continuous infusion. Pain scores, sedation level and analgesic requirements were recorded for the first 4 hours period in every 15 minutes and then 12 and 24 hours postoperatively.

Results: We found no difference between the groups for analgesic effectiveness. The sedation levels were lower for the postoperative first two hours in Group 1. After two hours, sedation levels were similar in the two groups.

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Discussion: Fentanyl is a well known and used agent for pain control in cardiac surgery. In our study we compared its postoperative effectiveness on analgesia and sedation with remifentanil. We concluded that remifentanil can be used at analgesic doses, as well as fentanyl, during recovery of patients undergoing fast-tract cardiac surgery.

References:

1 Olivier P, Siriex D, Dassier P, et al. Continuous infusion of remifentanil and targetcontrolled infusion of propofol for patients undergoing cardiac surgery: A new approach for scheduled early extubation. J Cardiothorac Vasc Anesth 2000; 14: 29-35.
2 Bowdle TA, Comporesi EM, Maysick L, et al. A multicenter evaluation of remifentanil for early postoperative analgesia. Anesth Analg 1996; 83: 1292-1297.
3 Calderon E, Pernia A, De Antonio P, et al. A comparison of two constant-dose continuous infusions of remifentanil for severe postoperative pain. Anesth Analg 2001; 92: 715-719.
© 2004 European Society of Anaesthesiology