Analgesia-based Sedation Using Remifentanil during Percutaneous Endoscopic Lumbar Discectomy

Hwang, Kyungil; Lee, Hoyeon; Shim, Kyudae; Kim, Dongyun; Shim, Chanshik; Lee, Sangho

Abstract

BACKGROUND: The aim of this study was to examine the safety and efficacy of sedation and analgesia using remifentanil during percutaneous endoscopic lumbar discectomy (PELD).
METHODS
Eighty ASA patients with physical status 1 or 2 who underwent a PELD were enrolled in this study. They were randomized to receive one of two treatments: a fentanyl bolus of 0.7microgram/kg 5 min before the procedure and of 0.7microgram/kg during the procedure (n = 40, group F), or a remifentanil titration at an infusion rate of 0.1-0.3microgram/kg/min available throughout the procedure according to the appeal of pain, level of sedation and side-effects (n = 40, group R). The observer's assessment of alertness/sedation (OAA/S) scale, blood pressure, heart rate, respiratory rate, SpO2, and end tidal CO2 were assessed and measured during and/or after the procedures. The visual analogue scale of pain (VAS), and the patient and endoscopist satisfaction scale were assessed after the procedures.
RESULTS
There were no significant differences between the two groups in terms of the recovery characteristics, incidence of complications and satisfaction score of patients. In 92.5% of the cases among the remifentanil group, the spine surgeon made uniform judgements that remifentanil worked better than the usually used fentanyl procedure, whereas in 7.5% of the cases the effects were indifferent. The VAS score of the R group was significantly lower than that of the F group.
CONCLUSIONS
We concluded that sedation and analgesia with remifentanil is very useful for painful local procedures such as PELDs.