Postoperative pain control following remifentanil-based anaesthesia for major abdominal surgery (original) (raw)
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Egyptian Journal of Anaesthesia, 2014
Background: Major abdominal surgeries induce neurohumoral changes responsible for postoperative pain, various organ dysfunctions and prolonged hospitalization. Inadequate pain control is harmful and costly to patients thus an appropriate pain therapy to those patients must be applicated. Methods: One hundred patients (ASA I or II) of either sex aged from 20 to 60 years were scheduled for elective major abdominal surgery. Patients were allocated randomly into two groups (fifty patients each) to receive: patient-controlled epidural analgesia with bupivacaine 0.125% and fentanyl (PCEA group), or patient controlled intravenous analgesia with fentanyl (PCIA group). Postoperative pain was assessed over 24 h using Numerical Pain Rating scale (NPRS). The frequency of rescue analgesia, sedation score and overall patient satisfaction were recorded. Any concomitant events like nausea; vomiting, shivering, pruritus or respiratory complications were recorded postoperatively. Results: There was a significant less pain in PCEA group at 2, 8 and 12 h. postoperative but PCIA group had less pain at immediate postoperative time. As regard sedation scale, patients of the PCEA group were significantly less sedated than PCIA group at immediate postoperative only. Overall patient satisfaction was significantly more in PCEA group.
IP Innovative Publication Pvt. Ltd., 2017
Introduction and Aims: The pain after major abdominal surgeries, if treated inadequately, may lead to increased postoperative morbidity and delayed recovery. The present study aims to compare continuous epidural infusion of ropivacaine-fentanyl with bupivacaine-fentanyl for postoperative analgesia in major abdominal surgeries. Materials and Method: This prospective, randomised, double blind study was conducted in 112 patients undergoing major abdominal surgeries. The patients were divided into two groups: each involving 56 patients. One group received 0.125% bupivacaine + 1µg/ml of fentanyl and the other received 0.2 % ropivacaine + 1 µg/ml of fentanyl. Both the infusions were started at a constant rate of 5 ml/h at the end of surgery. The Visual analogue scale (VAS) to assess pain, heart rate, systolic blood pressure, diastolic blood pressure, duration of surgery and anaesthesia, amount of crystalloids used and side effects were noted and compared at different time intervals. The data was analysed using SPSS 20.0 (trial version). Results: The mean of VAS pain score after 1,2,4,6,8,12 and 24 hours of surgery was less in RF group as compared to BF group and the total rescue analgesia consumption in 24 hours after surgery was 2.4 g (mean) in BF group and 1.3 g(mean) in RF group and the difference was statistically significant (P < 0.0001). There were no statistically significant differences in haemodynamic or physiologic variables when compared with both the groups. Conclusion: Analgesic potency and motor sparing effect of ropivacaine-fentanyl is better than bupivacaine-fentanyl at doses used in our study.
Acta Anaesthesiologica Scandinavica, 1984
Eighty patients undergoing upper abdominal surgery were randomly allocated to four groups according to the postoperative pain treatment. All patients had a standardized balanced anaesthesia and for postoperative analgesia either intramuscular oxycodone and/or metamizol (IM), intercostal block with 0.5% bupivacaine (IC), epidurally 4 mg morphine (EM) or i.v. infusion of fentanyl 0.54—0.99 μg min-1 + on-demand boluses of 7.2–13.5 μg (ODAG) were given. The pain intensity 2 h postoperatively was similar in all groups, mean score ranging from 3.2–4.3 on a scale from 0–10. At 24 h also, when additional intramuscular analgesics had been administered if needed, the mean pain scores did not vary much; 2.4 in the ODAC group to 3.4 in the IC group. The time until the first request for additional analgesia was longer in the EM group than in the IM group (7.5 h vs. 3.5 h). There were no differences between the groups in chest X-ray, peak expiratory flow or respiratory rate postoperatively, but in the capillary blood-gas analyses there was a greater number of slightly elevated Pco2 values (6.0–7.3 kPa) in the ODAC group than in the others. The amount of fentanyl infused in 24 h to the ODAC patients varied considerably, 814–2233 μg, as did the number of on-demand boluses, 3–155. At 24 h, an efficacy rating “good” was distributed as follows: IM 9/20, IC 11/20, EM 11/20 and ODAC 13/20. In the whole patient material 92.5% rated their condition as “good” or “fair”.
Open Journal of Anesthesiology, 2016
Post-operative analgesia is crucial to facilitate early ambulation, prevent complications, increase patient satisfaction while ensuring a faster recovery pace. Opioid analgesics have been recognized as the mainstay for treatment of acute pain in a majority of postoperative care units. Intravenous patient-controlled analgesia (IVPCA) with the opioids drugs sufentanil and fentanyl has proven to be effective when used in the immediate postoperative period. The aim of the study was to determine the efficacy and safety of sufentanil for postoperative analgesia based on the same principle, and, fentanyl citrate was chosen as a control drug for upper and lower abdominal operations under general anesthesia. Methodology; It was a prospective clinical study carried out at Union hospital, from December 2014 to March 2015. 240 patients were scheduled for upper and lower abdominal surgery requiring general anesthesia. They were divided into four groups: test group (A) and control group (B); (C) ...
Journal of Anaesthesiology Clinical Pharmacology, 2013
Background: Post-operative pain is often inadequately treated. Optimal utilization of the available resources is essential for improving pain management. Aims: The aim of our study was to determine pain management strategies employed after major abdominal surgeries at our institute and their efficacy and safety. Settings and Design: Prospective observational study conducted at a tertiary care hospital. Materials and Methods: Patients undergoing elective major abdominal surgeries were included. Post-operative analgesic strategy, co-analgesics used, pain and sedation scores, motor block, nausea and vomiting were recorded and patient satisfaction was determined. Results: Data was collected on 100 patients. Epidural analgesia was used in 61, patient controlled intravenous analgesia (PCIA) in 25 and opioid infusion in 14 patients. Multimodal analgesia was employed in 98 patients. The level of epidural was between L1-L3 in 31, T10-L1 in 20 and T8-T10 in 10 patients. Pethidine was used in 80% of patients receiving PCIA. Patients with epidurals at T8-T10 had lower pain scores. Fifteen patients had motor block, 73% of which were with epidural at L1-L3. Fourteen patients complained of nausea. Ninety nine out of 100 patients were satisfied with their analgesia. Conclusion: Epidural, PCIA and opioid infusions are used for pain relief after major abdominal surgeries at our hospital. Although there is limited drug availability, regular assessments and appropriate dose adjustments by acute pain management service (APMS) and use of multimodal analgesia led to a high level of patient satisfaction. We recommend that feedback to the primary anesthesiologists by APMS is of utmost importance to enable improvement in practice.
Journal of Clinical Anesthesia, 2000
Study Objective: To evaluate the effects of adding low concentration of fentanyl to 0.2% ropivacaine when providing patient-controlled epidural analgesia (PCEA) outside the Post-Anesthesia Care Unit. Design: Prospective, randomized, double-blind study. Setting: Inpatients at a University Department of Anesthesia. Patients: 32 ASA physical status I, II, and III patients, who were scheduled for elective major abdominal surgery, including bowel resection, hepatic resection, and pancreaticoduodenectomy. Interventions: Patients received standard general/epidural anesthesia. After surgery patients were randomly allocated in a double-blind fashion to receive PCEA with either 0.2% ropivacaine (n ϭ 16) or 0.2% ropivacaine/2 g/mL fentanyl (n ϭ 16) [background infusion ranging between 4 and 6 mL/hr, with 1.5-mL incremental doses and a 20-min lock-out time]. Dynamic pain during coughing, sedation, pulse oxymetry, hemodynamic variables, and motor block were evaluated at 1, 6, 12, 24, and 48 hours after the end of surgery by a blinded observer. Occurrence of untoward events, including nausea, vomiting, pruritus, need for supplemental oxygen (for SpO 2 Ͻ 90%), and respiratory complications, as well as total consumption of PCEA solution and incremental doses given to the patient were also recorded. Measurements and Main Results: No differences in pain relief, motor block, degree of sedation, recovery of gastrointestinal motility, and other side effects were observed between the two groups. Patients receiving 0.2% ropivacaine alone requested far more incremental doses (23 doses [0 -60] vs. 5 doses [0 -25]) (p ϭ 0.006) and needed far more analgesic solution (230 mL [140 -282] vs. 204 [130 -228]) (p ϭ 0.003) than patients receiving the ropivacaine/fentanyl mixture. Peripheral oxygen saturation was lower at 12, 24, and 48 hours during ropivacaine/fentanyl infusion than in patients receiving ropivacaine alone (12 h: 91% Ϯ 2% vs. 95% Ϯ 2%, p Ͻ 0.006; 24 h: 93% Ϯ 1% vs. 96% Ϯ 2%, p ϭ 0.003; 48 h: 92% Ϯ 1.8% vs. 96% Ϯ 1%, p ϭ 0.004).
Anesthesia: Essays and Researches, 2015
Background: Many adjuvants are used to increase the efficacy of epidural local anesthetics for postoperative analgesia. Aims: The aim was to compare the efficacy of epidural morphine (0.1 mg/kg) and clonidine (2 µg/kg) with bupivacaine (0.125%) for postoperative analgesia in abdominal surgeries. Settings and Design: Double-blind retrospective randomized study. Methodology: All the patients (n = 60) varying from age group belonging to American Society of Anesthesiologists I-II were randomly allocated to receive epidural analgesia Group A-Morphine (0.1 mg/kg). + Bupivacaine (0.125%) (n = 30), Group B-Clonidine (2 µ/kg) + Bupivacaine (0.125%) (n = 30). We monitored vitals and requirement of inhalational gases intra-operatively, pain by visual analogue score (VAS) and vitals postoperatively. We used rescue analgesics (injection diclofenac 1 mg/kg intravenous) when VAS score > 5. Postoperatively, various parameters were monitored for first 2 h at intervals of 30 min and at 4, 8, 12, 16, and 24 hourly intervals after giving 1 st dose. Statistical Analysis Used: Continuous data are analyzed by Student's t-test (paired 't'-test for intragroup variations and unpaired 't'-test for intergroup variations). Chi-square test was used for categorical data. A P ≤ 0.05 was considered to be statistically significant. Results: Mean duration of analgesia was 8.35 ± 0.42 h in Group A (morphine) and 7.45 ± 0.44 h in Group B (clonidine). This difference was statistically significant (P < 0.001), indicating a prolongation of analgesia in group morphine. There was no need of rescue analgesia in any subjects. Group A patients were hemodynamically stable and required less inhalation agents intra-operatively compared to group B patients. Conclusions: Epidural morphine plus bupivacaine has a longer duration of analgesia and greater hemodynamic stability as compared to epidural clonidine plus bupivacaine for postoperative analgesia in abdominal surgeries.
Anesthesia & Analgesia, 2000
We evaluated the effect of perioperative administration of two doses of morphine for postoperative analgesia after remifentanil-based anesthesia. The prospective, randomized study included 245 patients from 33 centers. All patients were scheduled for abdominal or urological surgery lasting more than 1 h. General anesthesia used remifentanil as the perioperative opioid (1 g/kg as a bolus then, 0.5 g/kg as a continuous infusion). A morphine bolus of 0.15 mg/kg (0.15-mg group) or 0.25 mg/kg (0.25-mg group) was administered 30 min before the end of surgery. In the postanesthesia care unit, pain scores for patients were evaluated by using behavioral pain scores of 1-3, verbal pain scores of 0-3, and visual analog scale scores of 0-10). Postoperative analgesia was obtained by a morphine titration (3 mg every 5 min). Demographic and surgery characteristics were similar in both groups. The delay for first demand of morphine was similar in the 0.15-mg and the 0.25-mg groups (26 [9-60] and 30 [10-60] min, respectively). The frequency of morphine titration was similar in both groups (75% and 66%, respectively). The amount of morphine used in the postanesthesia care unit was smaller in the 0.25-mg group (0.16 [0.0-1.25] vs 0.10 [0.0-0.56] mg/kg; P ϭ 0.008). In the 0.25-mg group, the behavioral pain score was lower at 15 min, the verbal pain score was lower at 60 min (P Ͻ 0.001), and similar at 30 min. The visual analog scale pain score at 30 min and 60 min was similar in both groups. The incidence of minor side effects was similar in both groups. However, three cases of postoperative respiratory depression occurred in the 0.25-mg group compared with no cases in the 0.15-mg group. In conclusion, perioperative administration of morphine alone does not provide entirely adequate immediate postoperative pain control after remifentanil-based anesthesia in major surgery. Implications: The administration of 0.15 or 0.25 mg/kg perioperative morphine during remifentanil-based anesthesia for major surgery does not preclude additional morphine administration in the postanesthesia care unit. The larger dose of 0.25 mg/kg slightly improves postoperative analgesia; however, it may be responsible for postoperative respiratory depression.