Effects of intraoperative high-dose vs low-dose remifentanil for postoperative epidural analgesia after gynecological abdominal surgery: a randomized clinical trial.
OBJECTIVE
To evaluate whether intraoperative high-dose remifentanil infusion increased local anesthetic consumption in postoperative epidural analgesia and postoperative pain scores compared with low-dose remifentanil infusion.


METHODS
Prospective, randomized controlled study.


METHODS
Operating room, university hospital.


METHODS
Thirty female patients scheduled for elective gynecological abdominal surgery.


METHODS
After epidural catheter placement and induction of general anesthesia, patients were randomly assigned to 2 anesthetic regimens. In the first group (high-dose remifentanil group), sevoflurane concentration was held constant at 1.2%, and the remifentanil infusion rate was titrated to maintain systolic blood pressure within 20% of baseline. In the second group (low-dose remifentanil group), the remifentanil infusion rate was held constant at 0.1μg/(kg min), and the sevoflurane concentration was titrated to maintain systolic blood pressure within 20% of baseline. As abdominal wall closure began, 6mL of 0.2% ropivacaine was administrated via epidural catheter; a patient-controlled analgesia device was set to deliver 4mL/h of 0.2% ropivacaine with 3μg/mL of fentanyl, with 2-mL incremental doses and a 15-minute lockout time.


METHODS
Local anesthetic consumption via postoperative epidural catheter and pain intensity with the Prince Henry pain scale were assessed for 48hours after surgery.


RESULTS
The mean remifentanil infusion rate was 0.23μg/(kg min) in the high-dose remifentanil group, 2.3 times the rate used in the low-dose remifentanil group. The cumulative amount of local anesthetic used within 48hours of surgery was significant greater in the high-dose remifentanil group than in the low-dose remifentanil group (212±25mL vs. 181±35mL, respectively; P<.05), but postoperative pain scores were similar in each group.


CONCLUSIONS
Intraoperative high-dose remifentanil infusion increased local anesthetic consumption in postoperative epidural analgesia relative to low-dose remifentanil.
Department of Anesthesiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. Electronic address: soichi2003@aol.com.
Soichiro
S
Yamashita
Department of Anesthesia, Ibaraki Prefectural Central Hospital, Kasama, Japan.
Takako
T
Yokouchi
Department of Anesthesiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
Makoto
M
Tanaka
D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural / Q000379:methods*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy*; D010880:Piperidines / Q000627:therapeutic use*; D011446:Prospective Studies; D000077208:Remifentanil; D016896:Treatment Outcome; D055815:Young Adult
D000701:Analgesics, Opioid; D010880:Piperidines; D000077208:Remifentanil
Epidural analgesia; General anesthesia; Hyperalgesia; Postoperative pain; Remifentanil