Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-19T07:51:47.924Z Has data issue: false hasContentIssue false
  • English
  • Français

The effect of fentanyl and remifentanil, with or without ketoprofen, on pain after thyroid surgery: a randomized-controlled trial

Published online by Cambridge University Press:  04 April 2006

C. Motamed ,
J. C. Merle ,
X. Combes ,
L. Yakhou ,
J. Vodinh  and
P. Duvaldestin
C. Motamed
Affiliation:
Université Paris 12, Hôpital Henri Mondor, Service d'Anesthésie Réanimation, APHP, Créteil, France
J. C. Merle
Affiliation:
Université Paris 12, Hôpital Henri Mondor, Service d'Anesthésie Réanimation, APHP, Créteil, France
X. Combes
Affiliation:
Université Paris 12, Hôpital Henri Mondor, Service d'Anesthésie Réanimation, APHP, Créteil, France
L. Yakhou
Affiliation:
Université Paris 12, Hôpital Henri Mondor, Service d'Anesthésie Réanimation, APHP, Créteil, France
J. Vodinh
Affiliation:
Université Paris 12, Hôpital Henri Mondor, Service d'Anesthésie Réanimation, APHP, Créteil, France
P. Duvaldestin
Affiliation:
Université Paris 12, Hôpital Henri Mondor, Service d'Anesthésie Réanimation, APHP, Créteil, France
Get access

Extract

Summary

Background and objectives: This study was designed to quantify the additional postoperative analgesic efficacy of a single dose of ketoprofen in patients undergoing thyroid surgery using two different intraoperative analgesic regimens. Methods: One hundred and twenty patients were randomly assigned to one of four groups: intraoperative fentanyl or remifentanil with or without ketoprofen (n = 30 for each group). Intravenous ketoprofen (1.5 mg kg−1) or saline was administered 45 min before the end of surgery. Pain scores, opioid demand and length of stay in the postanaesthesia care unit were assessed in a blinded manner. Results: Patients receiving intraoperative fentanyl with saline had significantly lower visual analogue scale pain scores in the postanaesthesia care unit compared with those receiving intraoperative remifentanil with saline (55 ± 10 mm vs. 80 ± 18 mm, P < 0.05) and they stayed shorter in the postanaesthesia care unit (86 ± 24 min vs. 126 ± 37 min). In conjunction with intraoperative fentanyl, ketoprofen significantly decreased postoperative pain scores (40 ± 10 mm, P < 0.05 compared with fentanyl alone) and opioid demand (4 of 30 patients vs. 14 of 30 patients compared with fentanyl alone, P < 0.05). Patients receiving intraoperative remifentanil had no additional analgesic benefit with ketoprofen. Conclusion: After thyroid surgery, patients receiving intraoperative fentanyl had lower pain scores and needed less rescue analgesia compared with patients receiving intraoperative remifentanil. The adjunction of ketoprofen further improved analgesia in patients who received intraoperative fentanyl only.

Keywords

SURGERY, thyroidANALGESICS OPIOID, fentanyl, remifentanilPAIN, POSTOPERATIVEANTI-INFLAMMATORY AGENTS, NON-STEROIDAL, ketoprofen
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 8 , August 2006 , pp. 665 - 669
Copyright
© 2006 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Albrecht S, Schuttler J, Yarmush J. Postoperative pain management after intraoperative remifentanil. Anesth Analg 1999; 89: S40–S45.Google Scholar
Abbas SM, Kamal RS, Afshan G. Effect of ketorolac on postoperative pain relief in dental extraction cases – a comparative study with pethidine. J Pak Med Assoc 2004; 54: 319–322.Google Scholar
Karamanlioglu B, Arar C, Alagol A et al. Preoperative oral celecoxib versus preoperative oral rofecoxib for pain relief after thyroid surgery. Eur J Anaesthesiol 2003; 20: 490–495.Google Scholar
Vach B, Kurzova A, Malek J et al. Infiltration of local anesthetics into the thyroid gland capsule for surgery and the postoperative period. Rozhl Chir 2002; 81: 519–522.Google Scholar
Aunac S, Carlier M, Singelyn F, De Kock M. The analgesic efficacy of bilateral combined superficial and deep cervical plexus block administered before thyroid surgery under general anesthesia. Anesth Analg 2002; 95: 746–750.Google Scholar
Sunshine A, Olson NZ, Zighelboim I, De Castro A. Ketoprofen, acetaminophen plus oxycodone, and acetaminophen in the relief of postoperative pain. Clin Pharmacol Ther 1993; 54: 546–555.Google Scholar
Owen H, Glavin RJ, Shaw NA. Ibuprofen in the management of postoperative pain. Br J Anaesth 1986; 58: 1371–1375.Google Scholar
Dershwitz M, Randel GI, Rosow CE et al. Initial clinical experience with remifentanil, a new opioid metabolized by esterases. Anesth Analg 1995; 81: 619–623.Google Scholar
Burkle H, Dunbar S, Van Aken H. Remifentanil: a novel, short-acting, mu-opioid. Anesth Analg 1996; 83: 646–651.Google Scholar
Hachenberg T. Perioperative management with short-acting intravenous anesthetics. Anaesthesiol Reanim 2000; 25: 144–150.Google Scholar
Cafiero T, Di Minno RM, Sivolella G, Di Iorio C. Immediate postoperative pain management in patients undergoing major abdominal surgery after remifentanil-based anesthesia: sufentanil vs tramadol. Minerva Anestesiol 2004; 70: 661–669.Google Scholar
Basto ER, Waintrop C, Mourey FD et al. Intravenous ketoprofen in thyroid and parathyroid surgery. Anesth Analg 2001; 92: 1052–1057.Google Scholar
Motamed C, Merle JC, Yakhou L et al. Intraoperative i.v. morphine reduces pain scores and length of stay in the post anaesthetic care unit after thyroidectomy. Br J Anaesth 2004; 93: 306–307.Google Scholar
Shafer SL. The role of newer opioids in geriatric anesthesia. Acta Anaesthesiol Belg 1998; 49: 91–103.Google Scholar
Guignard B, Bossard AE, Coste C et al. Acute opioid tolerance: intraoperative remifentanil increases postoperative pain and morphine requirement. Anesthesiology 2000; 93: 409–417.Google Scholar
Cortinez LI, Brandes V, Munoz HR et al. No clinical evidence of acute opioid tolerance after remifentanil-based anaesthesia. Br J Anaesth 2001; 87: 866–869.Google Scholar
Dirks J, Moiniche S, Hilsted KL, Dahl JB. Mechanisms of postoperative pain: clinical indications for a contribution of central neuronal sensitization. Anesthesiology 2002; 97: 1591–1596.Google Scholar
Doyle PW, Coles JP, Leary TM et al. A comparison of remifentanil and fentanyl in patients undergoing carotid endarterectomy. Eur J Anaesthesiol 2001; 18: 13–19.Google Scholar
Guo X, Yi J, Ye T et al. Comparison of remifentanil and fentanyl in patients undergoing modified radical mastectomy or total hysterectomy. Chin Med J (Engl) 2003; 116: 1386–1390.Google Scholar
Betancourt JW, Kupp LI, Jasper SJ, Farooqi OA. Efficacy of ibuprofen–hydrocodone for the treatment of postoperative pain after periodontal surgery. J Periodontol 2004; 75: 872–876.Google Scholar
Beers RA, Calimlim JR, Uddoh E et al. A comparison of the cost-effectiveness of remifentanil versus fentanyl as an adjuvant to general anesthesia for outpatient gynecologic surgery. Anesth Analg 2000; 91: 1420–1425.Google Scholar
Albrecht S, Fechner J, Geisslinger G et al. Postoperative pain control following remifentanil-based anaesthesia for major abdominal surgery. Anaesthesia 2000; 55: 315–322.Google Scholar
Casati A, Albertin A, Fanelli G et al. A comparison of remifentanil and sufentanil as adjuvants during sevoflurane anesthesia with epidural analgesia for upper abdominal surgery: effects on postoperative recovery and respiratory function. Anesth Analg 2000; 91: 1269–1273.Google Scholar
Damen SL, Nieuwenhuijs VB, Joosten W et al. The effects of remifentanil and sufentanil on the quality of recovery after day case laparoscopic cholecystectomy: a randomized blinded trial. J Laparoendosc Adv Surg Tech A 2004; 14: 87–92.Google Scholar
Davis PJ, Finkel JC, Orr RJ et al. A randomized, double-blinded study of remifentanil versus fentanyl for tonsillectomy and adenoidectomy surgery in pediatric ambulatory surgical patients. Anesth Analg 2000; 90: 863–871.Google Scholar
Defechereux T, Meurisse M, Hamoir E et al. Hypnoanesthesia for endocrine cervical surgery: a statement of practice. J Altern Complem Med 1999; 5: 509–520.Google Scholar
Defechereux T, Degauque C, Fumal I et al. Hypnosedation, a new method of anesthesia for cervical endocrine surgery. Prospective randomized study. Ann Chir 2000; 125: 539–546.Google Scholar
Hiller A, Silvanto M, Savolainen S, Tarkkila P. Propacetamol and diclofenac alone and in combination for analgesia after elective tonsillectomy. Acta Anaesth. Scand 2004; 48: 1185–1189.Google Scholar