Patient-Controlled Analgesia With
Remifentanil-Tci Compared With Piritramide Bolus Therapy For Shock Wave
Lithotrypsy
S Schraag, T Schierdewan, U Mohl, M Georgieff
Department of Anaesthesiology, University of Ulm, D-89075 Ulm, Germany
Background and Goal of study: Patient-controlled analgesia (PCA) and sedation with remifentanil has been used for extracorporal shock wave lithotripsy because it allows for rapid individualized titration. However, an increased incidence of respiratory adverse events is frequently observed with remifentanil when given as a bolus [1]. We tested whether Remifentanil target controlled infusion (TCI) would improve efficacy of analgesia and patient satisfaction compared to standard practice during ESWL.
Materials and Methods: After obtained institutional ethic`s committee approval and written informed consent, 44 patients with ureter and kidney stones undergoing ESWL were studied. They were allocated randomly to receive either Remifentanil-TCI PCA (Group 1) or Piritramide bolus doses, with an initial of 7.5 mg, followed by 3.75 mg thereafter (Group 2) in a double-blind, double-dummy study design. Patient satisfaction (PS), efficacy of analgesia (VAS) and the quality of recovery score (QRS) [2] were obtained three hours and 2 days after the procedure. Statistical analysis was performed using Wilcoxon signed ranks test with a significance level of a<0.05.
Results and Discussion: Patient characteristics and gender distribution were comparable between both groups. Main results (median, interquartil range) are listed in the table below (*denotes significance):
|
Time |
Criteria |
Remifentanil (n=21) |
Piritramide (n=23) |
p-value |
|
Day 1
(3h) |
VAS (0-10) |
1 (1-2) |
3 (1-4) |
0.03* |
|
|
PS (0-10) |
9 (9-19) |
9 (8-10) |
0.164 |
|
|
QRS (0-18) |
16 (13-17) |
15.5(14-17) |
0.527 |
|
|
Nausea (%) |
33 (7 of 21) |
39 (9/23) |
n.a. |
|
Day 2 |
VAS (0-10) |
2 (1-2.5) |
3 (2-5) |
0.19* |
|
|
PS (0-10) |
9 (9-10) |
9 (8-10) |
0.273 |
|
|
QRS (0-18) |
16 (13-17) |
14 (12-16) |
0.273 |
|
|
Nausea (%) |
33 (7 of 21) |
43 (10/23) |
n.a. |
There was no evidence of respiratory depression in either treatment group.
Conclusion: Remifentanil administered as a patient-controlled TCI significantly improved efficacy of analgesia during ESWL compared to standard practice. However, overall patient satisfaction and quality of recovery was equally good in both groups with a trend in favour of remifentanil.
References:
[1] Joo HS et al. Anesth Analg
2001 ;93 :1227-32
[2] Myles PS et al. Anesth Analg 1999 ;88 :83-90