The efficiency of IV PCA with remifentanil and ketorolac after laparoscopic-assisted vaginal hysterectomy

Abstract

BackgroundThis randomized, double-blinded clinical study was designed to evaluate the efficiency and safety of remifentanil with ketorolac for IV PCA after laparoscopic-assisted vaginal hysterectomy.MethodsEighty patients were randomly allocated into four groups. Group R received IV PCA using only remifentanil at a basal rate of 0.025 µg/kg/min and a bolus of 0.375 µg/kg. Group RK1 received IV PCA using remifentanil at a basal rate of 0.015 µg/kg/min and a bolus of 0.225 µg/kg. Group RK2 received IV PCA using remifentanil at a basal rate of 0.0075 µg/kg/min and a bolus of 0.1125 µg/kg. Group F received IV PCA using fentanyl at a basal rate of 0.3 µg/kg/h and a bolus of 0.075 µg/kg. In addition, ketorolac at a basal rate of 0.04 mg/kg/h and a bolus of 0.01 mg/kg was added to Group RK1, RK2, and F. All PCA conditions had a lock out period of 15 minutes. Pulse rate, systolic and diastolic BP, sedation score, visual analogue scale (VAS), and PONV score were recorded at 1, 3, 6, 12, and 24 hours after the operation. Total opioid use and the patients' number for rescue analgesic drug were also collected.ResultsThe groups did not differ in PONV score and hemodynamic changes. The VAS in Group RK2 was high compared with the other groups. In addition, the sedation score was high in Group R.ConclusionsThe additional ketorolac administration in remifentanil IV PCA had remifentanil sparing effects and reduced sedation among the side effects. Further studies will be needed to evaluate the precise and adequate dosage of ketorolac.

The efficacy of the time-scheduled decremental continuous infusion of fentanyl for postoperative patient-controlled analgesia after total intravenous anesthesia

“…Patients were randomized to one of the three groups (FX2-2-2, D6-4-2 and D8-4-2) consisting of 33 patients in each group, using Excel© 'Random' function (Microsoft Office® Excel 2007). In FX2-2-2, the background infusion rate was maintained at a fixed-rate of 2.0 ml/hr until postoperative 24 hr, without changing the infusion rate [ 5 , 7 ]. In decremental infusion groups, the infusion rates were maintained at 6.0 ml/hr (D6-4-2) and 8.0 ml/hr (D8-4-2) until postoperative 1 hr, respectively, and decreased to maintain at 4.0 ml/hr during postoperative 1-3 hr.…”

“…1 ). Therefore, the analgesic concentration in the body might be insufficient to the severity of the early postoperative pain during the fixed-rate infusion of the recommended regimens (< 1.1 µg/kg/hr) [ 1 , 5 , 7 , 13 , 14 ]. But fixed-set to higher rates (1.25-2.0 µg/kg/hr) [ 6 , 13 ] might increase the risk of side effects, such as ventilatory depression, while 50% depressing the slope of the ventilation-CO 2 response curve at the C p of fentanyl between 2.0-3.1 ng/ml [ 15 ].…”

The evaluation of implementing smart patient controlled analgesic pump with a different infusion rate for different time duration on postoperative pain management

“…Despite the different rates of infusion, the amount of morphine infused at 6 hours after the operation and 24 hours after the operation was similar in both groups. This suggests that the patients in the control group pushed the bolus button more frequently than the patients in the test group because of postoperative pain; this is because early concentrations of analgesics cannot adequately control the level of postoperative pain when infused in small doses at a fixed rate in PCA [ 13 14 ]. Although morphine was infused at an identical rate of 0.5 ml/h at 24-48 h after the operation in both groups, a higher amount of morphine was used in the control group than the test group during this time interval, and over 48 hours postoperatively.…”

Continuous Fentanyl Background Infusion Regimen Optimised by Patient-Controlled Analgesia for Acute Postoperative Pain Management: A Randomised Controlled Trial

“…A programmable PCA infuser (PS-1000, Unimedics Corp., Ltd., Seoul, Korea) filled with 100 mL of fentanyl diluent was prepared, and each fentanyl diluent was prepared according to body weight of 0.25 µg/kg per 1.0 mL of diluent, using normal saline [14]. The infuser was connected at the proximal portion of the patient's indwelling cannula using a three-way stopcock, and an anti-reflux one-way valve was inserted to prevent the back-flow to the gravity infusion line for anticipated occlusions.…”

“…Despite this, acute postoperative pain control can be inadequate during the initial postoperative period [7][8][9] due to various factors, including the pharmacokinetic properties of fentanyl. When fentanyl is infused at a constant rate within the recommended regimens (<1.1 µg/kg/h) [6,[10][11][12][13][14], the effect-site concentration (C eff ) of fentanyl shows a delayed increase until a steady-state of the C eff is reached, despite PCA demand-doses [15]. Therefore, PCA with time-scheduled decremental BI rates (TDBI), which initially increases and then gradually decreases the BI rate seems more effective than PCA with a constant rate BI (CRBI) [15].…”