Postoperative condition after the use of remifentanil with a small dose of
piritramide compared with a fentanyl-based protocol in patients undergoing
craniotomy.
Author(s): van der Zwan T, Baerts WD, Perez RS, de Lange JJ.
Affiliation(s): VU University Medical Centre, Department of Anesthesiology, Amsterdam, The
Netherlands. tvdzwan@kabelfoon.nl
Publication date & source: 2005, Eur J Anaesthesiol. , 22(6):438-41
BACKGROUND AND OBJECTIVE: The use of remifentanil requires other analgesics for
postoperative pain relief compared to fentanyl in patients undergoing craniotomy.
This could possibly reduce the postoperative advantages of this short-acting
opioid.
METHODS: We compared remifentanil and fentanyl-based anaesthesia in a randomized
observer and patient blinded trial on patients, undergoing an elective
craniotomy. Twenty patients received anaesthesia using remifentanil with a small
dose of piritramide (0.1 mg kg(-1)) after closure of the dura mater. Twenty
patients underwent a fentanyl-based protocol. In both groups, anaesthesia was
induced with thiopental and rocuronium, and maintained with 0.6-1 minimum
alveolar concentration (MAC) isoflurane in a nitrous oxide/oxygen mixture 2:1 and
rocuronium. Patients received 1 g of paracetamol rectally postoperatively. A
visual analogue scale (VAS) for pain, the Glasgow Coma Score, a modified Aldrete
Score, arterial carbon dioxide tension (PaCO2) and piritramide consumption were
evaluated every half an hour postoperatively.
RESULTS: No significant differences were found for pain, Aldrete or Glasgow Coma
scores or for PaCO2 between the groups when controlled for age, although the pain
and Glasgow Coma Scores were consistently higher and PaCO2 lower in the
remifentanil group. Furthermore, 11 out of 20 patients in the remifentanil group
requested extra piritramide as opposed to 7 out of 20 in the fentanyl group (P =
0.11).
CONCLUSIONS: Despite the intraoperative use of piritramide in the remifentanil
group, patients experienced more pain postoperatively. A significant influence of
age on pain intensity was found. The use of remifentanil with a small dose of
piritramide of 0.1 mg kg(-1) has no evident advantage over the use of fentanyl
considering the postoperative conditions after craniotomy.
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