title: A prospective, randomized, double-blind, multicenter study comparing remifentanil with fentanyl in mechanically ventilated patients.
abstract: OBJECTIVE
  To compare the quality of analgesia provided by a remifentanil-based analgesia regime with that provided by a fentanyl-based regime in critically ill patients.
  
  
  METHODS
  This was a registered, prospective, two-center, randomized, triple-blind study involving adult medical and surgical patients requiring mechanical ventilation (MV) for more than 24 h. Patients were randomized to either remifentanil infusion or a fentanyl infusion for a maximum of 30 days. Sedation was provided using propofol (and/or midazolam if required).
  
  
  RESULTS
  Primary outcome was the proportion of patients in each group maintaining a target analgesia score at all time points. Secondary outcomes included duration of MV, discharge times, and morbidity. At planned interim analysis (n = 60), 50% of remifentanil patients (n = 28) and 63% of fentanyl patients (n = 32) had maintained target analgesia scores at all time points (p = 0.44). There were no significant differences between the groups with respect to mean duration of ventilation (135 vs. 165 h, p = 0.80), duration of hospital stay, morbidity, or weaning. Interim analysis strongly suggested futility and the trial was stopped.
  
  
  CONCLUSIONS
  The use of remifentanil-based analgesia in critically ill patients was not superior regarding the achievement and maintenance of sufficient analgesia compared with fentanyl-based analgesia.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Charité-Universitaetsmedizin Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany. claudia.spies@charite.de
authors.forename: Claudia
authors.initials: C
authors.lastname: Spies
authors.forename: Martin
authors.initials: M
authors.lastname: Macguill
authors.forename: Anja
authors.initials: A
authors.lastname: Heymann
authors.forename: Christina
authors.initials: C
authors.lastname: Ganea
authors.forename: Daniel
authors.initials: D
authors.lastname: Krahne
authors.forename: Angelika
authors.initials: A
authors.lastname: Assman
authors.forename: Heinrich-Rudolf
authors.initials: HR
authors.lastname: Kosiek
authors.forename: Kathrin
authors.initials: K
authors.lastname: Scholtz
authors.forename: Klaus-Dieter
authors.initials: KD
authors.lastname: Wernecke
authors.forename: Jörg
authors.initials: J
authors.lastname: Martin
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000494:pharmacology*; D003243:Consciousness / Q000187:drug effects*; D003422:Critical Care / Q000379:methods; D004311:Double-Blind Method; D023381:Endpoint Determination; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000494:pharmacology*; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D010880:Piperidines / Q000008:administration & dosage / Q000494:pharmacology*; D011446:Prospective Studies; D000077208:Remifentanil; D012121:Respiration, Artificial
chemical_list: D000701:Analgesics, Opioid; D010880:Piperidines; D000077208:Remifentanil; D005283:Fentanyl