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This anecdote illustrates the point that a remi infusion can have undesirable unintended consequences. Do you really want your patient to be behind the eightball postop?
What's the point of intraoperative narcotics?
- Thread starter RxBoy
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This anecdote illustrates the point that a remi infusion can have undesirable unintended consequences. Do you really want your patient to be behind the eightball postop?
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The one case I really like to use remi is with bronchoscopies. Not painful at all afterwards, but extremely stimulating and usually on pulmonary cripples.
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Dexmedetomidine versus remifentanil in postoperative pain control after spinal surgery: a randomized controlled study
DOI: 10.1186/s12871-015-0004-1
© Hwang et al.; licensee BioMed Central. 2015
Received: 29 August 2014
Accepted: 18 February 2015
Published: 24 February 2015
Open Peer Review reports
Abstract
Background
Total intravenous anesthesia (TIVA) is used widely in spinal surgery because inhalational anesthetics are known to decrease the amplitude of motor evoked potentials. Presently, dexmedetomidine is used as an adjuvant for propofol-based TIVA. We compared the effects of remifentanil and dexmedetomidine on pain intensity as well as the analgesic requirements after post-anesthesia care unit (PACU) discharge in patients undergoing spinal surgery.
Methods
Forty patients scheduled for posterior lumbar interbody fusion (PLIF) surgery under general anesthesia were enrolled. Anesthesia was maintained using propofol at 3–12 mg/kg/h and remifentanil at 0.01–0.2 μg/kg/min in Remifentanil group or dexmedetomidine at 0.01–0.02 μg/kg/min in Dexmedetomidine group, keeping the bispectral index between 40 and 60. Patient-controlled analgesia (PCA) made of hydromophone was applied once the patients opened their eyes in the PACU. The visual analog scale (VAS) score, PCA dosage administered, and postoperative nausea and vomiting (PONV) were recorded at the time of discharge from the PACU (T1) and at 2 (T2), 8 (T3), 24 (T4), and 48 hours (T5) after surgery.
Results
The VAS score in Remifentanil group was significantly higher than that in Dexmedetomidine group at immediate and late postoperative period (4.1 ± 2.0 vs. 2.3 ± 2.2 at T1, and 4.0 ± 2.2 vs. 2.6 ± 1.7 at T5; P < 0.05). Dexmedtomidine group had a statistically significantly lower PCA requirement at every time point after surgery except directly before discharge from the PACU (3.0 ± 1.2 ml vs. 2.3 ± 1.4 ml at T1; P > 0.05, but 69.7 ± 21.4 ml vs. 52.8 ± 10.8 ml at T5; P < 0.05). Patients in Remifentanil group displayed more PONV until 24 hours post-surgery.
Conclusions
Dexmedetomidine displayed superior efficacy in alleviating pain and in postoperative pain management for 48 hours after PLIF. Therefore, dexmedetomidine may be used instead of remifentanil as an adjuvant in propofol-based TIVA.
http://bmcanesthesiol.biomedcentral.com/articles/10.1186/s12871-015-0004-1
- Wonjung Hwang,
- Jaemin Lee,
- Jihyun Park and
- Jin JooEmail author
DOI: 10.1186/s12871-015-0004-1
© Hwang et al.; licensee BioMed Central. 2015
Received: 29 August 2014
Accepted: 18 February 2015
Published: 24 February 2015
Open Peer Review reports
Abstract
Background
Total intravenous anesthesia (TIVA) is used widely in spinal surgery because inhalational anesthetics are known to decrease the amplitude of motor evoked potentials. Presently, dexmedetomidine is used as an adjuvant for propofol-based TIVA. We compared the effects of remifentanil and dexmedetomidine on pain intensity as well as the analgesic requirements after post-anesthesia care unit (PACU) discharge in patients undergoing spinal surgery.
Methods
Forty patients scheduled for posterior lumbar interbody fusion (PLIF) surgery under general anesthesia were enrolled. Anesthesia was maintained using propofol at 3–12 mg/kg/h and remifentanil at 0.01–0.2 μg/kg/min in Remifentanil group or dexmedetomidine at 0.01–0.02 μg/kg/min in Dexmedetomidine group, keeping the bispectral index between 40 and 60. Patient-controlled analgesia (PCA) made of hydromophone was applied once the patients opened their eyes in the PACU. The visual analog scale (VAS) score, PCA dosage administered, and postoperative nausea and vomiting (PONV) were recorded at the time of discharge from the PACU (T1) and at 2 (T2), 8 (T3), 24 (T4), and 48 hours (T5) after surgery.
Results
The VAS score in Remifentanil group was significantly higher than that in Dexmedetomidine group at immediate and late postoperative period (4.1 ± 2.0 vs. 2.3 ± 2.2 at T1, and 4.0 ± 2.2 vs. 2.6 ± 1.7 at T5; P < 0.05). Dexmedtomidine group had a statistically significantly lower PCA requirement at every time point after surgery except directly before discharge from the PACU (3.0 ± 1.2 ml vs. 2.3 ± 1.4 ml at T1; P > 0.05, but 69.7 ± 21.4 ml vs. 52.8 ± 10.8 ml at T5; P < 0.05). Patients in Remifentanil group displayed more PONV until 24 hours post-surgery.
Conclusions
Dexmedetomidine displayed superior efficacy in alleviating pain and in postoperative pain management for 48 hours after PLIF. Therefore, dexmedetomidine may be used instead of remifentanil as an adjuvant in propofol-based TIVA.
http://bmcanesthesiol.biomedcentral.com/articles/10.1186/s12871-015-0004-1
I'm not saying to not use opiods and I have not perfected a one cocktail wonder for all. All I am saying is that things have changed and giving tons of opiods may lead to some problems later on. I think you can still get OIH with any narcotic, not just remi. If I gave you fentanyl everyday for 1 month straight don't you think we would have some negative effects (Wind-up, sensitization, OIH etc) I give narcotics but not nearly the amount I use to. I have seen CRNA's give very large doses of opiods intraop and in PACU needing a good amount of pain medicine for avg cases. They were my cases, so I would watch them in PACU afterwards. I can do the same case w/ half the amount and have the patient in better shape. Hey that is my opinion, but I agree with Mman that "some" data is out/coming out suggesting we limit opiod usage. By limit I do not mean zero, I just mean don't be as judicious as in the past.
