A randomised trial comparing sufentanil versus remifentanil for laparoscopic gastroplasty in the morbidly obese patient.

ABSTRACT

BACKGROUND AND OBJECTIVE: This prospective, randomised double-blind study compared the effects of target control infusion (TCI) of sufentanil and remifentanil on the quality of recovery and post-operative pain control in morbidly obese patients undergoing laparoscopic gastroplasty. METHODS: Following institutional Ethics Committee approval and written informed consent, 100 morbidly obese patients were randomised to receive either TCI sufentanil (0.3 ng ml⁻¹; S-group; N = 50) or TCI remifentanil (3 ng ml⁻¹; R-group; N = 50) in combination with desflurane (O2/air mixture FiO2, 50%). Quality of recovery was estimated by means of the modified Aldrete score and by the ability to perform psychomotor tests with the same competence post-operatively as pre-operatively. Post-operative pain was evaluated by the quantity of piritramide needed to achieve a visual analogue scale (VAS) less than 3. Statistical analysis was performed using an unpaired Student's t-test, Mann-Whitney U-test and χ² test, as appropriate. RESULTS: Patient and surgical characteristics were similar among groups. In the R-group, time to extubation was significantly shorter, but VAS significantly higher than that in the S-group (P < 0.01). Quality of recovery and duration of post-anaesthesia care unit stay were comparable between groups (S-group 119 ± 27 min and R-group 119 ± 35 min). Piritramide consumption during the first 4 post-operative hours was higher in the R-group than in the S-group [S-group (median, range) 11.5 mg, 5.5-16.0; R-group 18.0 mg, 14-22, P < 0.01], but not later on. CONCLUSION: In the conditions of the present study, although TCI sufentanil resulted in slower awakening than TCI remifentanil, it was associated with a better quality of recovery.