Comparative analysis of remifentanil versus dexmedetomidine in the incidence of pain in a post-anesthesia care unit after bariatric surgery

Abstract

BACKGROUND AND OBJECTIVES: Compare anesthesia techniques with sufentanil and intraoperative infusion of remifentanil or dexmedetomidine, and to then analyze their associations with the incidence of pain and other complications in the post-anesthesia care unit. METHODS: A retrospective analytical observational study conducted in a reference center for bariatric surgery in São Paulo, São Paulo State, Brazil. Patients (n=120) included in the study were randomly selected using this site's anesthesia records for bariatric surgery. Four 30-patient groups were established: G1-induction with 0.5 µg.kg-1 sufentanil associated with the continuous infusion of remifentanil; G2-induction with 0.7 µg.kg-1 sufentanil associated with the continuous infusion of remifentanil; G3-induction with 0.5 µg.kg-1 sufentanil associated with the continuous infusion of dexmedetomidine; and G4-induction with 0.7 µg.kg-1 sufentanil associated with the continuous infusion of dexmedetomidine. Significance was set at p<0.05. RESULTS: The incidence of pain in the post-anesthesia care unit was 52.5% (n=63). It was considered intense in 36.11% of these cases. The incidence of pain in the post-anesthesia care unit was lower in patients receiving a continuous infusion of dexmedetomidine relative to those who received remifentanil infusion. Sufentanil dosage in anesthesia induction did not influence the incidence of pain (G1=G2>G3=G4; p<0.05). The occurrence of respiratory complications did not differ significantly between the groups. CONCLUSION: The use of dexmedetomidine proved to be better for analgesia in the post-anesthesia care unit, and it did not increase the risk of respiratory complications when compared to the continuous infusion of remifentanil, regardless of the sufentanil dose used for induction.

Comparative analysis between patients undergoing Gastric Bypass and Sleeve Gastroplasty in a private hospital in Sao Luis-MA

“…Although not statistically relevant between the two surgical procedures, pain in this study was found more prevalent in patients undergoing the Bypass procedure in the first hours after surgery. A similar percentage was found in another study 42 , with the incidence of pain in the Post Anesthetic Recovery Room (PACU) being 52.5% (n = 63); 36.11% reported severe pain (defined as a score of 8 to 10 on the numeric scale). The incidence of postoperative pain after bariatric surgery in patients undergoing general anesthesia is a factor to be considered when choosing intraoperative anesthetics 42 .…”

Intraoperative, sociodemographic, and postoperative parameters in individuals undergoing bariatric surgery

“…In this sense, the half-life of the anesthetics used may be directly related to an anesthesia time of fewer than 100 min, as some studies have shown 18 , while in the present study, the average was superior to 150 min in both groups. Nevertheless, the more intense postoperative pain in the group submitted to the sleeve in the first hours after surgery may be intrinsically related to the anesthetics used intraoperatively, as observed in another study 21 , with the choice of anesthetic drugs being a factor that should be taken into account during the intraoperative period of patients undergoing bariatric surgery.…”