Postoperative Pain Clinical Trial
Official title:
Remifentanil vs Fentanyl During Day Case Dental Surgery in Persons With Special Needs: a Comparative Study of Their Effect on Stress Response and Postoperative Pain
This study was a prospective comparative study. The purpose of this study was to investigate the hypothesis whether remifentanil compared to fentanyl can induce less inflammatory and stress response to the day-case dental surgery in Persons with special needs (PSN). Secondary aims were to investigate comparatively their effect on patients intraoperative hemodynamic response and postoperative analgesia.
The study included 46 adult patients with cognitive impairment who underwent day-case dental
surgery under general anesthesia with propofol aiming to keep a BIS-values range between
40-45. Nasal tracheal intubation was performed in all patients while neuromuscular blockade
was achieved by rocuronium 0.6 mg/kg iv and repetitive doses of rocuronium of 10 mg iv, if
needed.
Patients were randomly allocated receive for intraoperative analgesia either fentanyl 50 μg
iv bolus (group F, n=23) or continuous infusion of remifentanil 0.5-1 μg/kg/min (group R,
n=23). Randomization was performed using using a computer-generated randomization schedule.
Intraoperatively, patients in both groups received IV granisetron 3 mg, methylprednisolone
125 mg and clindamycin 600 mg, while atropine 0.02 mg/kg and neostigmine (0.05 mg/kg) was
administered to to reverse neuromuscular blockade. Intraoperative monitoring included
non-invasive measurement of arterial blood pressure, electrocardiogram, pulse oxymetry,
capnography and Bispectral Sedation Index (BIS®).
Postoperatively, patients remained under surveillance in the post-anesthesia care unit
[PACU] for 3 h. Postoperative pain was assessed for the first 12 postoperative hours, at 30
min time-intervals for the first 3 hours, and every 3 hours thereafter by an independent
observer, blinded to the study group, using the Wong-Baker faces pain rating scale (0-6). If
pain scores were ≥3 a rescue dose of paracetamol 12.5 mg/kg iv was administered.
Inflammation markers and stress hormones [cortisol, Tumor necrosis factor (TNF-a),
substance-P, melatonin and β-endorphin] were measured in each patient before induction of
anesthesia, after tracheal intubation and at the end of operation.
Statistical Analysis was performed using Kolmogorov-Smirnov test, Student's unpaired t-test
or Repeated Measures ANOVA with Holm's post-hoc analysis appropriately. A p value less than
0.05 was considered statistically significant.
;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Investigator, Outcomes Assessor), Primary Purpose: Prevention
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