Remifentanil versus propofol as adjuncts to regional anesthesia. Remifentanil 3010 Study Group.
J Clin Anesth
; 10(1): 46-53, 1998 Feb.
Article
en En
| MEDLINE
| ID: mdl-9526938
ABSTRACT
STUDY OBJECTIVE:
To compare the safety and efficacy of remifentanil and propofol as adjuncts to regional anesthesia in patients undergoing orthopedic or urogenital surgery.DESIGN:
Prospective, randomized study.SETTING:
Multicenter university hospitals. PATIENTS 107 ASA physical status I, II, and III adult patients who underwent orthopedic or urogenital surgery with axillary, ankle, or spinal block.INTERVENTIONS:
Patients were randomized to receive either an infusion of remifentanil 0.2 microg/kg/min or propofol 100 microg/kg/min 5 minutes before nerve block placement. The infusions were decreased by 50% on block completion, increased by 50% for patient discomfort, and decreased by 50% for hypoventilation (< 8 breaths/min) or hemodynamic instability. MEASUREMENTS AND MAINRESULTS:
Pain, discomfort, anxiety, and sedation were assessed by both patient and investigator. Vital signs and adverse events were recorded. Fewer patients in the remifentanil group experienced pain during block placement (6%), and were oversedated (7%) than patients in the propofol group (23% and 26%, respectively; p < 0.05). Hypoventilation during and after block placement (21% and 25%, respectively) and nausea and vomiting during and after block placement (60% and 21%, respectively) were more common in the remifentanil group than in the propofol group (0% and 3%; 17% and 6%, respectively; p < 0.05). The incidence of hypoventilation in remifentanil-treated patients was higher in patients over 65 years of age (p < 0.05), but was transient, resolving within minutes of discontinuing the infusion.CONCLUSIONS:
At the doses studied, remifentanil was more effective than propofol in minimizing pain without producing excessive sedation. Remifentanil was associated with more transient respiratory depression and short-term nausea. Our findings indicate that the initial remifentanil rate should be 0.1 microg/kg/min (50% lower than the study's initial rate) and should be further decreased an additional 50% in the elderly to minimize adverse effects.
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Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Piperidinas
/
Propofol
/
Anestésicos Intravenosos
/
Anestesia de Conducción
Tipo de estudio:
Clinical_trials
/
Observational_studies
/
Risk_factors_studies
Límite:
Adult
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
J Clin Anesth
Asunto de la revista:
ANESTESIOLOGIA
Año:
1998
Tipo del documento:
Article
País de afiliación:
Estados Unidos