Immediate postoperative pain management in patients undergoing major abdominal
surgery after remifentanil-based anesthesia: sufentanil vs tramadol. [Article in English, Italian]
Author(s): Cafiero T(1), Di Minno RM, Sivolella G, Di Iorio C.
Affiliation(s): Author information:
(1)Department of Anesthesia, Postoperative Intensive Care, Burn Center and
Hyperbaric Center A. Cardarelli Hospital, Naples, Italy. tcafiero@tiscali.it
Publication date & source: 2004, Minerva Anestesiol. , 70(9):661-9
AIM: The transition from intraoperative analgesia to postoperative analgesia must
be planned carefully after remifentanil-based anesthesia, due to the short
duration of action of remifentanil. The aim of this study is to compare the
efficacy and safety of 2 transition strategies using sufentanil or tramadol for
early postoperative pain relief in patients who had major abdominal surgery under
general anesthesia with remifentanil/sevoflurane.
METHODS: Sixty patients participated in this double-blind, prospective study and
were randomly assigned to either sufentanil (S) group or tramadol (T) group.
Twenty minutes before the end of surgery the patients received either a bolus of
0.15 microg kg(-1) sufentanil (group S) or tramadol 100 mg (group T). Mean
arterial pressure (MAP), heart rate (HR) and rate pressure product (RPP=systolic
arterial pressure (SAP)xHR), analgesia by a verbal rating score (VRS) and
sedation by a sedation score (SS) were evaluated at emergence from anesthesia.
RESULTS: A statistically significant difference in HR between the 2 groups was
recorded at extubation (78+/-13 in group S vs 86+/-24 in group T). A significant
decrease of RPP values at extubation and 5 minutes later were found in group S in
comparison with group T. VRS values were significantly lower in sufentanil group
at 5 and 10 minutes after awakening.
CONCLUSIONS: Sufentanil provided more effective transition analgesia in
comparison with tramadol. The effects of remifentanil dissipated rapidly and
analgesia with major opioids was required. A bolus dose of sufentanil 0.15 microg
kg(-1) was efficacious in controlling the hemodynamic parameters at awakening
from anesthesia. The lower HR values and, consequently the lower RPP values are
of utmost importance especially in the aged cardiovascular risk patient.
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