Remifentanil PCA

Remifentanil PCA

PEP Topic 
Acute Pain
Description 

Remifentanil is an opioid that is a fentanyl derivative. Researchers have examined the effectiveness of remifentanil administered by patient controlled analgesia (PCA) in managing acute pain.

Effectiveness Not Established

Research Evidence Summaries

Lipszyc, M., Winters, E., Engelman, E., Baurain, M., & Barvais, L. (2011). Remifentanil patient-controlled analgesia effect-site target-controlled infusion compared with morphine patient-controlled analgesia for treatment of acute pain after uterine artery embolization. BJA: The British Journal of Anaesthesia, 106(5), 724–731.

doi: 10.1093/bja/aer041
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Study Purpose:

To compare the analgesic effects of remifentanil target-controlled infusion via patient-controlled analgesia (PCA) to morphine PCA after uterine artery embolization

Intervention Characteristics/Basic Study Process:

Nineteen patients were randomized into either the remifentanil group or the morphine group. Pain was evaluated every 15 minutes for 2 hours after the procedure and then at 4, 8, 12, and 16 hours after the procedure. Hemodynamic stability and respiratory stability were also measured.

Sample Characteristics:

  • The sample was composed of 19 patients.
  • Information about the age of patients is unavailable.
  • All patients were female.
  • All patients had a leiomyomata.
  • All patients underwent uterine artery embolization.
     

Setting:

  • Single site
  • Inpatient
     

Phase of Care and Clinical Applications:

Phase of care: active treatment

Study Design:

Double-blinded randomized controlled trial

Measurement Instruments/Methods:

  • Numeric pain scale, 0–10    
  • etCO2 readings, SpO2 measurements, respiratory rate/minute, to measure respiratory stability
  • Heart rate, measures of blood pressure, to measure hemodynamic stability
     

Results:

  • During the first four hours after surgery, pain scores were significantly lower (p < 0.02) in the remifentanil group than in the morphine group. After that, morphine and remifentanil showed similar effectiveness in controlling pain.
  • One patient in the remifentanil and morphine groups, respectively, needed rescue pain therapy.
  • Respiratory and hemodynamic stability were not significantly different between the groups.

Conclusions:

The study concludes that, in the first four hours after surgery, remifentanil was more effective than morphine in reducing pain scores and that remifentanil PCA was as safe as morphine PCA.

Limitations:

The study had a small sample size, with fewer than 30 patients.

Nursing Implications:

Further studies should evaluate the ability of remifentanil to control pain after uterine artery embolization.


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