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REGIONAL ANESTHESIA AND PAIN MEDICINE

A Comparison of Two Constant-Dose Continuous Infusions of Remifentanil for Severe Postoperative Pain

Anesthesiology Department, Puerta del Mar University Hospital, Cádiz, Spain

Address correspondence to E. Calderon, MD, PhD, Hospital U. Puerta del Mar, Avd Ana de Viya 21. 10. 09—Cádiz, Spain.

We evaluated the analgesic efficacy and safety of two continuous constant-dose infusions of IV remifentanil, without infusion rate increments or the addition of boluses, in patients with severe postoperative pain during the first 4 h after general anesthesia with IV propofol-remifentanil. Thirty patients were randomly assigned to two groups of 15 subjects each according to the remifentanil dose administered: 0.1 µg · kg^-1 · min^-1 IV (Group A) or 0.05 µg · kg^-1 · min^-1 IV (Group B). Rescue analgesia was provided with meperidine (0.5 mg/kg IV) when pain intensity on the simple verbal scale (SVS) 2. The criteria for adequate analgesia (SVS 0–1, respiratory frequency >8/min. and SpO₂ >90%) after 4 h were met by 78% and 75% of the patients in Groups A and B, respectively (P = ns). "Meperidine rescue" analgesia was significantly more in Group B (26%) than in Group A (6%) (P < 0.05). There were no cases of respiratory depression, and nausea and emesis occurred in one patient in each group (6.5%). We conclude that IV remifentanil is an effective and safe opioid for the treatment of postoperative pain at a constant dose of 0.1 µg · kg^-1 · min^-1 with a need for rescue analgesia 4 times less than a constant dose of 0.05 µg · kg^-1 · min^-1.

Implications: Our study suggests that the use of a constant continuous infusion of remifentanil 0.1 µg·kg^-1·min^-1IV is an effective alternative in the treatment of severe postoperative pain.

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