Propofol-TCI and remifentanil-MCI vs remifentanil-TCI sedation as adjuvant of local anesthesia for orthopaedic surgery. A randomized clinical trial

Adela Onuţu¹, Daniela Ionescu², Adina Răduţ², Delia Deac¹, Ioana Iacob¹, D. Lucaciu³

1 Departamentul de Anestezie şi Terapie Intensivă, Spitalul Clinic de Urgenţă „Prof. Dr. Octavian Fodor”, Cluj-Napoca
2 Catedra de Anestezie şi Terapie Intensivă a UMF „Iuliu Haţieganu”, Cluj-Napoca
3 Catedra de Ortopedie şi Traumatologie a UMF „Iuliu Haţieganu”, Cluj-Napoca

Abstract

Background. The aim of this randomized controlled study was to compare 2 methods of sedation: propofol-TCI and remifentanil-MCI vs remifentanil-TCI for short orthopedic procedures.

Patients and method. After written informed consent, 40 patients, ASA I-II, scheduled for osteosynthesis material removal from the ankle under local anesthesia with 1% lidocaine were randomized into 2 groups: group PR received propofol-TCI Cp = 1.7 µg/ml and remifentanil-MCI 0.1 µg/kg/min and group R received remifentanil-TCI Cp = 2 ng/ml. Heart rate (HR), mean blood pressure (MAP), respiratory rate (RR), oxygen saturation (SpO2) were recorded. Sedation was assessed using modified Wilson scale and recorded at 5 minutes intervals. Side-effects, pain scores (VAS), recovery time, surgeon’s satisfaction at the end of the procedure and patient’s satisfaction at 24 hours after the procedure (IOWA Satisfaction Scale) were also recorded.

Results. Mean sedation score during the procedure was 3.35 + 0.53 in PR as compared with 2.06 + 0.30 in group R (p = 0.001). Pain score (VAS) at the end of procedure was 2.02 + 0.52 in PR group and 2.56 + 0.51 in R group (p = 0.03). There were no significant differences in satisfaction scores between study groups (p = 0.18). In PR group, one patient developed respiratory depression with a SpO2 88%.

Conclusions. TCI remifentanil sedation associated to local anesthesia techniques for short orthopedic procedures was superior to propofol-TCI and remifentanil-MCI regarding sedation and lack of respiratory depression, while the pain score (VAS) was significantly increased. Patients’ satisfaction was similar in both groups.

Keywords: sedation, propofol, remifentanil, TCI, satisfaction

J Rom Anest Terap Int 2010; 17: 17-22

STUDII CLINICE

Sedarea cu propofol TCI şi remifentanil MCI versus remifentanil TCI ca adjuvant al anesteziei locoregionale în chirurgia ortopedică. Un studiu prospectiv, randomizat