Postoperative Analgesia with Remifentanil vs Morphine-Metamizole Following Cardiac Surgery
AJTES Vol. 5, No 2, July 2021.
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Keywords

Pain
Remifentanil
morphine-metamizole
cardiac surgery

How to Cite

Ibrahimi, A., Kuci, S., Bejko, E., Llazo, S., Goga, M., Likaj, E., Dumani, S., Refatllari, A., & Zeitani, J. (2021). Postoperative Analgesia with Remifentanil vs Morphine-Metamizole Following Cardiac Surgery. Albanian Journal of Trauma and Emergency Surgery, 5(2), 838-841. https://doi.org/10.32391/ajtes.v5i2.249

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.

https://doi.org/10.32391/ajtes.v5i2.249
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References

1. 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.
2. Berger JT, Rosner F. The ethics of practice guidelines. Arch Intern Med. 1996;156(18):2051–2056. doi:10.1001/archinte.1996.00440170053006
3. 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
4. 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
5. 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
6. 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
7. 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.
8. 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
9. 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
10. Coriat P, Beaussier M. Fast-tracking after coronary artery bypass graft surgery. Anesth Analg 2001; 92: 1081–3
11. 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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