title: Remifentanil sedation compared with propofol during regional anaesthesia.
abstract: BACKGROUND
  The short onset and offset of remifentanil may allow for accurate dosing of sedative effect with few side-effects and rapid recovery. In this study remifentanil is compared with propofol for sedation during successful regional anaesthetic blocks.
  
  
  METHODS
  After informed consent was given, 125 patients undergoing surgery under spinal or brachial plexus anaesthesia were randomized to receive, either propofol: bolus 500 microg/kg plus initial infusion 50 microgkg/min or remifentanil: bolus 0.5 microg/kg plus initial infusion 0.1 microgkg/min. Study drug infusion rate was titrated throughout the procedure according to level of sedation and side-effects. Pain, discomfort, sedation level and side-effects were recorded at regular intervals until discharge from the post operative care unit (PACU).
  
  
  RESULTS
  Two patients in the remifentanil group versus ten in the propofol group were treated for discomfort or pain during surgery (P<0.02). Due to a significantly higher rate of respiratory depression (46% vs. 19% with propofol, P<0.01) the mean remifentanil infusion rate was decreased to 0.078 +/- 0.028 microgkg/min, whereas it was kept stable with propofol. Propofol patients had significantly higher (P<0.05) sedation levels and experienced more frequent amnesia of the procedure. Eleven propofol patients experienced pain at injection site, versus two remifentanil patients (P<0.02). Nausea and vomiting were more frequent in the remifentanil patients during infusion (27% vs. 2% in the propofol group, P<0.001) but similar postoperatively. Time to discharge from PACU was similar in the two groups.
  
  
  CONCLUSIONS
  Propofol results in less respiratory depression and nausea when sedation is needed during a case with a successful regional block. Remifentanil may be considered as an alternative if pain during the procedure is a major concern or if amnesia is contraindicated.
authors.affiliation: Service d' Anesthésie-Réanimation Chirurgicale, Hôpital Bichat, Paris, France. frederique.servin@bch.ap-hop-paris.fr
authors.forename: F S
authors.initials: FS
authors.lastname: Servin
authors.forename: J C
authors.initials: JC
authors.lastname: Raeder
authors.forename: J C
authors.initials: JC
authors.lastname: Merle
authors.forename: M
authors.initials: M
authors.lastname: Wattwil
authors.forename: A L
authors.initials: AL
authors.lastname: Hanson
authors.forename: M H
authors.initials: MH
authors.lastname: Lauwers
authors.forename: A
authors.initials: A
authors.lastname: Aitkenhead
authors.forename: J
authors.initials: J
authors.lastname: Marty
authors.forename: K
authors.initials: K
authors.lastname: Reite
authors.forename: S
authors.initials: S
authors.lastname: Martisson
authors.forename: L
authors.initials: L
authors.lastname: Wostyn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000765:Anesthesia, Conduction; D016292:Procedural Sedation; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010880:Piperidines / Q000009:adverse effects; D015742:Propofol / Q000009:adverse effects; D000077208:Remifentanil; D016037:Single-Blind Method
chemical_list: D006993:Hypnotics and Sedatives; D010880:Piperidines; D000077208:Remifentanil; D015742:Propofol