Abstract
This study assessed the effect of sufentanil administered before conclusion of remifentanil-based anaesthesia on postoperative hyperalgesia and haemodynamic stability in patients undergoing laparoscopic gynaecological surgery. The patients were randomly allocated to a sufentanil administration group (S group) or a normal saline administration group (C group). Anaesthesia was induced and maintained with controlled administration of remifentanil at 10 ng·mL−1 and propofol under bispectral index guidance. Once the surgical specimen was procured, sufentanil or normal saline was administered at 0.15 ng·mL−1 and maintained until extubation. The haemodynamic status during anaesthetic emergence was evaluated. The pain and postoperative nausea and vomiting (PONV) were assessed for 72 h following postanaesthetic care unit (PACU) discharge. The S group had significantly lower mean systemic arterial blood pressure and heart rate changes between the start of drug administration and extubation. Postoperative pain was significantly lower in the S group until 24 h following PACU discharge. There were no significant differences in PONV incidence and severity 72 h after PACU discharge between the two groups. Sufentanil administration before concluding remifentanil-based anaesthesia improved postoperative hyperalgesia and achieved haemodynamic stability at extubation without delaying recovery or increasing PONV during laparoscopic gynaecological surgery. Clinical trial registration is found at KCT0000785.
Highlights
The combination of propofol as a hypnotic agent and remifentanil as an analgesic agent is the most popular regimen for achieving stable haemodynamic and surgical states during total intravenous anaesthesia (TIVA) [1,2,3]
82 patients were eligible and 4 patients were excluded: 2 patients in the C group were excluded for conversion to open laparotomy, 1 patient in the sufentanil administration group (S group) was receiving concurrent breast surgery, and 1 patient in the S group was unable to participate in the interview because of mental retardation
The target plasma concentration of sufentanil (0.15 ng⋅mL−1) and the target tissue concentration of sufentanil (0.14 ± 0.01 ng⋅mL−1) at Te were confirmed in S group
Summary
The combination of propofol as a hypnotic agent and remifentanil as an analgesic agent is the most popular regimen for achieving stable haemodynamic and surgical states during total intravenous anaesthesia (TIVA) [1,2,3]. A patient administered a high intraoperative remifentanil dose may experience increased postoperative pain requiring additional analgesic agents immediately following remifentanil cessation [6, 7]. Sufentanil administration during emergence from desflurane general anaesthesia reduced the postoperative analgesic requirement without increasing postoperative nausea and vomiting (PONV) [10]. We hypothesized that sufentanil administration before anaesthetic conclusion may prevent postoperative hyperalgesia and haemodynamic instability during remifentanil-based anaesthesia. The Scientific World Journal the effect of sufentanil administered before the conclusion of anaesthesia on postoperative hyperalgesia and haemodynamic parameters during laparoscopic gynaecological surgery under remifentanil-based anaesthesia
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