Keywords
Remifentanil
morphine-metamizole
cardiac surgery
How to Cite
Abstract
Background: Pain management after cardiac surgery has been based on parenteral long-acting opioids such as morphine. The other alternative is remifentanil. We compared the efficacity of remifentanil vs morphine -metamizole for post cardiac surgery pain relief.
Methods; Twenty patients undergoing on-pump coronary artery bypass surgery, receiving standardized propofol–fentanyl and propofol based anesthesia, remifentanil group (Group R, n = 10) and fentanyl (Group F, n = 10). Postoperative analgesia was provided in R group initially with remifentanil and later with morphine-metamizole and in F group immediately after operation. Pain was controlled by visual observation, questioning, in rest and during coughing, with a score (0-3).
Results; There is no difference in time of extubation between groups but, pain score was much higher in F (3-9) group in first hour compared with R group (0-4). Morphine requirements was higher in (R) after remifentanil was stopped, in a first hour, but was lower after 24 hours compared with F group. Conclusion: Use of remifentanil is associated with lower scale of pain in postoperative period and lower morphine requirement after 24 hours, when analgesia treatment was changed.
References
Bair N, Bobek MB, Hoffman-Hogg L, Mion LC, Slomka J, Arroliga AC. Introduction of sedative, analgesic, and neuromuscular blocking agent guidelines in a medical intensive care unit: physician and nurse adherence. Crit Care Med. 2000;28(3):707–713.
Berger JT, Rosner F. The ethics of practice guidelines. Arch Intern Med. 1996;156(18):2051–2056. doi:10.1001/archinte.1996.00440170053006
Dasta JF, Fuhrman TM, McCandles C. Patterns of prescribing and administering drugs for agitation and pain in patients in a surgical intensive care unit. Crit Care Med. 1994;22(6):974–980. doi:10.1097/ 00003246-199406000-00016
Analgesia and sedation post-coronary artery bypass graft surgery: a review of the literature Mansour Jannati and Armin Attar Ther Clin Risk Manag. 2019; 15: 773–781. Published online 2019 Jun 20. doi: 10.2147/TCRM.S195267
Myles PS, Hunt JO, Fletcher H, Watts J, Bain D, Silvers A. Remifentanil, fentanyl, and cardiac surgery: a double-blinded, randomized, controlled trial of costs and outcomes. Anesth Analg 2002; 95: 805–1
Lehmann A, Zeitler C, Thaler E, Isgro F, Boldt J. Comparison of two different anesthesia regimens in patients undergoing aortocoronary bypass grafting surgery: sufentanil-midazolam versus remifentanil-propofol. J Cardiothoracic Vasc Anesth 2000; 14: 416–20
Boris Khanykin , Rizwan Siddiqi , Per F Jensen , Dennis R Bigler , Gennady V Atroshchenko Comparison of remifentanil and low-dose fentanyl for fast-track cardiac anesthesia: a prospective randomized study Heart Surg Forum 2013 Dec;16(6):E3248 doi:10.1532/HSF98.2013229.
Howie MB, Cheng D, Newman MF, et al. A randomized doubleblinded multicenter comparison of remifentanil versus fentanyl when combined with isoflurane/propofol for early extubation in
coronary artery bypass graft surgery. Anesth Analg 2001; 92:1084–93
Engoren M, Glenn L, Fenn-Buderer N. A comparison of fentanyl, sufentanil, and remifentanil for fast-track cardiac anesthesia. Anesth Analg 2001; 93: 859–64
Coriat P, Beaussier M. Fast-tracking after coronary artery bypass graft surgery. Anesth Analg 2001; 92: 1081–3
Remifentanil infusion in association with fentanyl–propofol anaesthesia in patients undergoing cardiac surgery: effects on morphine requirement and postoperative analgesia K. Rauf, A. Vohra*, P. Fernandez-Jimenez, N. O’Keeffe and M. Forrest British Journal of Anaesthesia 95 (5): 611–15 (2005)
doi:10.1093/bja/aei237 Advance Access publication September 9, 2005
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