Influence of intraoperative opioid on postoperative pain and pulmonary function after laparoscopic gastric banding: remifentanil TCI vs sufentanil TCI in morbid obesity.
BACKGROUND
Choice of opioid may influence postoperative pain, recovery, and respiratory homeostasis in morbid obesity. The aim of this study was to compare the effects of target-controlled infusions (TCIs) of remifentanil or sufentanil on postoperative analgesia, recovery, and pulmonary function after laparoscopic gastric banding.


METHODS
Forty morbidly obese patients undergoing laparoscopic gastric banding received BIS-guided desflurane anaesthesia combined with remifentanil TCI (Group R) or sufentanil TCI (Group S). Intraoperative haemodynamic stability, BIS controllability, and immediate recovery in the operating room were measured. Pulmonary function, modified Aldrete score, modified Observers Assessment of Alertness and Sedation score, blood gas analysis, and visual analogue score for pain and postoperative nausea and vomiting were measured on admission to the post-anaesthesia care unit and 30, 60, 120 min afterwards. After operation, patients received patient-controlled analgesia with morphine.


RESULTS
During the first two postoperative hours, cumulative morphine consumption was higher in the remifentanil group compared with the sufentanil group, but was equal values after that time. Recovery profiles and spirometry showed no significant differences. During maintenance, remifentanil gave a better haemodynamic stability.


CONCLUSIONS
As few differences occurred in the postoperative period, the theoretical advantage of remifentanil over the longer acting sufentanil can be questioned when using TCI technology.
De Baerdemaeker
L E C
LE
Department of Anaesthesia, Ghent University Hospital, Ghent, Belgium. luc.debaerdemaeker@ugent.be
Jacobs
S
S
Pattyn
P
P
Mortier
E P
EP
Struys
M M R F
MM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D000762:Anesthesia Recovery Period; D001794:Blood Pressure / Q000187:drug effects; D004334:Drug Administration Schedule; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects; D015391:Gastroplasty; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D009767:Obesity, Morbid / Q000601:surgery*; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy / Q000517:prevention & control*; D010880:Piperidines / Q000008:administration & dosage / Q000627:therapeutic use*; D000077208:Remifentanil; D016037:Single-Blind Method; D017409:Sufentanil / Q000008:administration & dosage / Q000627:therapeutic use*; D014797:Vital Capacity / Q000187:drug effects
D000701:Analgesics, Opioid; D010880:Piperidines; D009020:Morphine; D017409:Sufentanil; D000077208:Remifentanil