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Transition to post-operative epidural or patient-controlled intravenous analgesia following®total intravenous anaesthesia with remifentanil and propofol for abdominal surgery

Published online by Cambridge University Press:  16 August 2006

T. A. Bowdle ,
L. B. Ready ,
E. D. Kharasch ,
W. W. Nichols  and
K. Cox
T. A. Bowdle
Affiliation:
Department of Pharmaceutics, University of Washington, Seattle WA 98195, USA
L. B. Ready
Affiliation:
Department of Anaesthesiology, University of Washington, Seattle WA 98195, USA
E. D. Kharasch
Affiliation:
Department of Medicinal Chemistry, University of Washington, Seattle WA 98195, USA
W. W. Nichols
Affiliation:
Department of Anaesthesiology, University of Washington, Seattle WA 98195, USA
K. Cox
Affiliation:
Department of Anaesthesiology, University of Washington, Seattle WA 98195, USA
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Abstract

Remifentanil is an ultrashort acting mu opioid, well suited to total intravenous (i.v.) anaesthesia. Pain immediately following emergence from anaesthesia is a potential problem because of the rapid offset. This study investigated the transition from remifentanil/propofol total intravenous anaesthesia to post-operative analgesia with epidural or patient controlled analgesia morphine in 22 patients undergoing major abdominal surgery. A remifentanil post-operative infusion initiated during emergence was titrated in the recovery room for 30 min, at which time 14% of patients had a pain score of 2 and 86% had pain scores of 0 or 1 (0 = no pain; 1 = mild pain; 2 = moderate pain; 3 = severe pain), at a mean infusion rate of 0.086 mug kg −1 min −1 . A smooth transition was then made to either epidural analgesia or patient controlled analgesia with morphine; pain scores were not significantly changed during the transition. Nausea occurred in 16 of the 22 patients, but only following administration of morphine. Epidural analgesia produced significantly lower pain scores on the surgical ward compared with patient controlled analgesia.

Keywords

anaesthesiaintravenousremifentanilpropofolanalgesicsremifentanilpainpost-operativeanaesthetic techniquesepiduralpatient-control analgesia
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 14 , Issue 4 , July 1997 , pp. 374 - 379
Copyright
1997 European Society of Anaesthesiology

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