Intravenous Patient-controlled Analgesia using Remifentanil after Cardiac Surgery / 대한마취과학회지

BACKGOUND: For rapid onset and predictable elimination half life, remifentanil may be suitable for patients undergoing cardiac surgery with unstable vital sign and decreased metabolism. We evaluated the efficacy, safety and proper dosage of intravenous patient-controlled analgesia (IV PCA) using remifentanil in patients undergoing cardiac surgery. METHODS: Forty-nine patients scheduled for cardiac surgery with sternotomy were randomly allocated to three groups. Group F had IV PCA using fentanyl with basal rate of 0.3microgram/kg/h, bolus of 0.5microgram/kg and lockout time of 15 min. Group L had remifentanil IV PCA with basal rate of 4microgram/kg/h, and group S with basal rate of 1microgram/kg/h. Both of group L and group S had setting of bolus of 0.5microgram/kg and lockout time of 5 min. In 12, 24 and 36 hours after surgery, vital sign, arterial blood gas analysis, visual analog pain scale (VAS), sedation score, and incidences of side effects were evaluated. RESULTS: The VAS score of group L was significantly low until 24 hours after surgery compared with other groups (P < 0.001). In group L, sedation score and PaCO2 in 12 hours after surgery were significantly high compared with other groups (P < 0.05), but no treatments were needed. CONCLUSIONS: Remifentanil IV PCA with basal rate of 4microgram/kg/h showed lower VAS score compared with small dosage of remifentanil and fentanyl with basal rate of 0.3microgram/kg/h. In the safety and proper dosage, further evaluations were needed.

A Comparison of the Effect of Fentanyl and Fentanyl-Nalbuphine for Postoperative Analgesia Using IV-PCA / 대한마취과학회지

BACKGROUND: Patient-controlled analgesia (PCA) is effectively used for postoperative pain control. Fentanyl has a strong analgesic effect but has some side effects. The purpose of this study was to compare the side effects and analgesic effects of fentanyl alone and combination with nalbuphine in patients using intravenous PCA. METHODS: Forty six ASA class 1 or 2 patients were randomly divided into two groups. Group F (n = 23) received fentanyl 1,200microgram in 100 ml of normal saline. Group NF (n = 23) received nalbupine 60 mg and fentanyl 600microgram in 100 ml of normal saline. All patients used the same background infusion rate (2 ml/hr), bolus dose (2 ml) and lockout interval (15 min) just after emergence from general anesthesia. The analgesic effect was evaluated by using a visual analogue scale (VAS) at 1 hr, 6 hr, 12 hr, 24 hr and 48 hr postoperatively. Side effects and satisfaction degree were also checked. RESULTS: No significant differences were observed between the two groups in terms of pain scores and satisfaction degrees. The side effects were similar in both groups except that sedation was significantly (P<0.05) lower in group NF. CONCLUSIONS: We conclude that nalbuphine with fentanyl in combination is a useful method for intravenous PCA. On comparing the incidence of side effects in the two groups, sedation was found to be lower for the combined regimen.