Comparison of Postoperative Pain after Abdominal and Laparoscopic Assisted Vaginal Hysterectomy by using IV-PCA

Comparison of Postoperative Pain and Nausea and Vomiting between Desflurane and Desflurane-remifentanil Anesthesia for Gynecologic Laparoscopic Surgery

PURPOSE

The purpose of this study was to compare desflurane anesthesia with desflurane-remifentanil anesthesia by measuring postoperative pain, nausea and vomiting after gynecologic laparoscopic surgery.

METHODS

Data were collected using a random double blind method. The experimental group treated with desflurane-remifentanil anesthesia had a total of 25 patients. The control group had 20 patients who were treated with desflurane anesthesia. Pain (VAS), pushing PCA button, nausea and vomiting (VAS) were assessed at PACU (Post Anesthesia Care Unit) arrival, 10 min, 20 min, 30 min in PACU and 2 hrs, 6 hrs, 24 hrs, 48 hrs in ward. INVR was assessed at 24 hrs. Extra analgesics and extra antiemetics were measured in PACU and the ward. Data were analyzed using t-test and repeated measure using ANOVA.

RESULTS

The experimental group presented with more postoperative pain (F=7.55, p<.001) than the control group. The experimental group took more extra analgesics in PACU and pressed the PCA button more often for 6 hours. The experimental group complained more postoperative nausea (F=2.11, p=.043) than the control group and took extra antiemetics during postoperative period of 24 hours.

CONCLUSION

We conclude that desflurane-remifentanil anesthesia needs better management than desflurane anesthesia due to increased pain, nausea & vomiting after gynecologic laparoscopic surgery.

Continuous infusion of two doses of remifentanil immediately after laparoscopic-assisted vaginal hysterectomy

Background

We evaluated the effect and safety of the immediate postoperative continuous infusion of remifentanil at two doses in patients undergoing laparoscopic-assisted vaginal hysterectomy (LAVH) with alfentanil-based patient-controlled analgesia (PCA).

Methods

The study enrolled 50 ASA physical status 1 or 2 patients scheduled to undergo LAVH. Anesthesia was maintained with sevoflurane-remifentanil-air. At the last skin suture, the sevoflurane was discontinued, and patients were randomized to receive remifentanil 0.05 µg/kg/min (group I) or 0.1 µg/kg/min (group II). PCA was started at the time of eye opening and response to a verbal command. In the recovery room, we monitored the mean arterial blood pressure (MAP), heart rate (HR), respiratory rate (RR), SpO₂, and bispectral index (BIS) at 5-minute intervals. Thirty minutes after starting PCA, the remifentanil was discontinued. Pain was assessed using a visual analog scale (0 = no pain; 100 = the worst possible pain) at 0, 5, 10, and 30 minutes after stopping the remifentanil infusion.

Results

The eye opening time, BIS, MAP, and HR did not differ significantly between the two groups, and pain scores were similar between the two groups. Respiratory depression (SpO₂ < 90% or RR < 8/min) did not occur in group I but did occur in three patients in group II.

Conclusions

Continuous remifentanil infusion (0.05 µg/kg/min) immediately postoperatively with alfentanil-based PCA had a similar effect as a 0.1 µg/kg/min infusion with respect to pain control without side effects. However, special attention must be given to respiratory depression.

Remifentanil for postoperative patient-controlled analgesia after laparoscopic-assisted vaginal hysterectomy: dose-finding study

BACKGROUND

This randomized, double-blinded clinical study was designed to compare the efficacy and safety of three regimens of intravenous (IV) patient-controlled analgesia (PCA) with remifentanil for postoperative analgesia after laparoscopic-assisted vaginal hysterectomy during the first 24 postoperative hours.

METHODS

Thirty-four patients were randomly allocated into three groups. The first group received IV remifentanil PCA at a basal rate of 0.02 microgram/kg/min, a bolus of 0.3 microgram/kg, and a lockout time of 15 min. The second group received IV-PCA at a basal rate of 0.025 microgram/kg/min, a bolus of 0.375 microgram/kg, and a lockout time of 15 min. The third group received IV-PCA at a basal rate of 0.03 microgram/kg/min, a bolus of 0.45 microgram/kg, and a lockout time of 15 min. Age, weight, height, and duration of surgery and anesthesia were recorded. Heart rate, systolic and diastolic blood pressure (BP) and oxygen saturation by pulse oxymetry were recorded in the recovery room as a base line after the operation. Heart rate, systolic and diastolic BP, sedation score, visual analogue scale (VAS), and postoperative nausea and vomiting (PONV) scores were recorded at 1 h, 3 h, 6 h, 12 h, and 24 h after the initiation of IV-PCA.

RESULTS

Thirty two patients were evaluated. The VAS in group 1 at 1, 3 and 6 hours after surgery was significantly higher than in other groups (P < 0.05). There were no clinically relevant differences between the groups in PONV, sedation scores, or hemodynamic parameters.

CONCLUSIONS

This study suggests that IV remifentanil PCA with at a basal rate of 0.025 microgramram/kg/min (group 2) provided efficacious analgesia after laparoscopic-assisted vaginal hysterectomy. Special attention must be given to respiratory depression during establishment of PCA with remifentanil.