ORIGINAL ARTICLES  ANESTHESIA Free access

Minerva Anestesiologica 2004 January-February;70(1-2):45-52

Copyright © 2003 EDIZIONI MINERVA MEDICA

language: English, Italian

Analgesic transition after remifentanil-based anesthesia in neurosurgery. A comparison of sufentanil and tramadol

Cafiero T. ¹, Burrelli R. ², Latina P. ², Mastronardi P. ²

¹ Department of General and Specialistic Surgical Sciences A. Cardarelli Hospital, Naples, Italy 2 Department of Surgical, Anesthesiological, Resuscitation and Emergency Sciences Federico II University, Naples, Italy

Aim. Transition ­from the end of remi­fen­ta­nil infu­sion and post­op­er­a­tive anal­ge­sia ­must be ­planned care­ful­ly ­owing to ­remifentanil’s (R) rap­id off­set. Intraoperative mor­phine has ­been ­used for the tran­si­tion to post­op­er­a­tive anal­ge­sia fol­low­ing remi­fen­ta­nil-­based anes­the­sia. Sufentanil (S) is a ­very ­potent opi­oid ­with ­high µ-recep­tor affin­ity, a ­much wid­er ther­a­peu­tic ­index and a low­er frac­tion­al recep­tor occu­pan­cy. These phar­mac­o­log­i­cal and dynam­ics fea­tures ­make sufen­ta­nil an inter­est­ing alter­na­tive to mor­phine for imme­di­ate post­op­er­a­tive anal­ge­sia.
Methods. Experimental ­design: per­spec­tive, ran­dom­ized, sin­gle blind­ed and com­par­a­tive ­study. Institution: neu­ro­sur­gi­cal oper­at­ing thea­tre at University. Patients: 96 ­patients, ­aging ­from 25 to 67 ­years, ASA ­class I-III, under­go­ing neu­ro­sur­gi­cal oper­a­tions, ­were stud­ied. Interventions and Measurements: the anes­thet­ic man­age­ment was: pre­med­i­ca­tion: atropine 0.01 mg kg-1 + remifentanil 0.20 µg kg-1 min-1; induc­tion: propofol 2.0 mg kg-1 + cisat­ra­cu­ri­um 0.15 mg kg-1; main­te­nance: sevoflurane 0.8% + remifentanil (titrat­ed infu­sion) cisat­ra­cu­ri­um. All ­patients ­received ketor­o­lac 30 mg i.v. 1 ­hour ­before the end of sur­gery and ketor­o­lac (60-90 mg) + tram­a­dol (200-300 mg) by elas­to­mer­ic ­pump; ­patients ­were divid­ed ­into 2 ­groups: ­group T receiv­ing tram­a­dol 100 mg and ­group S receiv­ing a ­bolus ­dose of sufen­ta­nil 0.10 µg kg-1, 30 and 15 min­utes ­before the end of sur­gery respec­tive­ly. Recovery ­time, post­op­er­a­tive anal­ge­sia eval­u­at­ed by VAS, car­di­o­cir­cu­la­to­ry param­e­ters and ­side ­effects ­like nau­sea, vom­it­ing, shiv­er­ing, mus­cle rigid­ity, seda­tion and res­pir­a­to­ry depres­sion ­were record­ed.
Results. VAS was sig­nif­i­cant­ly low­er in Group S. Recovery ­time was short­er in Group T ­than in Group S (8.8±3.6 vs 11.6±4.6 min), no sta­tis­ti­cal­ly sig­nif­i­cant dif­fer­enc­es ­between ­groups as ­regards nau­sea, vom­it­ing and shiv­er­ing. Short-last­ing res­pir­a­to­ry depres­sion was detect­ed in 3 cas­es in Group S.
Conclusion. At the emer­gence ­much bet­ter con­trol of the tran­si­tion ­phase in ­patients treat­ed ­with sufen­ta­nil: ­smooth recov­ery ­with bet­ter tol­er­abil­ity of the endo­tra­cheal ­tube; effi­ca­cious anal­ge­sia ­along ­with car­di­o­cir­cu­la­to­ry stabil­ity.