[Analgesia and sedation in the subarachnoid anesthesia technique: comparative study between remifentanil and fentanyl/midazolam].

Abstract

OBJECTIVE:

To assess the efficacy and safety of remifentanil in comparison with fentanyl-midazolam for analgesia and sedation during subarachnoid anesthesia.

MATERIAL AND METHODS:

Sixty ASA I-III patients between 25 and 75 years old and scheduled for inguinal hernia repair were enrolled. Before the subarachnoid block, the patients were randomly assigned to receive an intravenous infusion of 0.1 microgram.Kg-1.min.-1 of remifentanil (group R) or 1 microgram.Kg-1 of fentanyl and 0.02 mg.Kg-1 of midazolam (group F). Ten minutes later a subarachnoid block to L3-L4 was performed with 10 mg of hyperbaric bupivacaine. We recorded intensity of pain during performance of the block on a simple verbal scale, the observer's assessment of alertness/sedation (OAA/S), hemodynamic variables, respiratory frequency and SpO2, level of comfort and side effects.

RESULTS:

Over 70% of patients had no pain or slight pain during the subarachnoid puncture and absence of pain was significantly greater in group R than in group F (37% vs. 16%, p < 0.05). Sedation was adequate during surgery in both groups (OAA/S 2-3). There were no differences in level of comfort between the two groups. The incidences of hypoxemia, hypoventilation and excessive sedation were significantly higher in group R (40%, 20% and 16%, respectively; p < 0.05).

CONCLUSIONS:

Remifentanil is more effective for treating pain associated with a subarachnoid block and provides cardiovascular stability with a limited level of sedation per dose, but its use is associated with a high incidence of respiratory depression.

• Authors: E Calderón, A Pernia, M D Román, A C Pérez, L M Torres
• Journal: Revista espanola de anestesiologia y reanimacion (Rev Esp Anestesiol Reanim) Vol. 50 Issue 3 Pg. 121-5 (Mar 2003) ISSN: 0034-9356 [Print] Spain
• Vernacular Title: Analgesia y sedación para la realización de la técnica de anestesia subaracnoidea: estudio comparativo entre remifentanilo y fentanilomidazolam.
• PMID: 12708207 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial)

Chemical References

• Analgesics, Opioid
• Hypnotics and Sedatives
• Piperidines
• Remifentanil
• Midazolam
• Fentanyl

Topics

• Adult
• Aged
• Analgesia
• Analgesics, Opioid
• Anesthesia, Spinal (methods)
• Conscious Sedation
• Fentanyl
• Hernia, Inguinal (surgery)
• Humans
• Hypnotics and Sedatives
• Male
• Midazolam
• Middle Aged
• Piperidines
• Prospective Studies
• Remifentanil