Evaluation of intraoperative and postoperative analgesia in patients undergoing laparoscopic cholecystectomy under general anesthesia with anesthetic induction performed using sufentanil or fentanyl. Comparative and randomized study
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Hypothesis Sufentanil, administered at the time of anesthetic induction, has the ability to reduce the need for the use of remifentanil intraoperatively when compared to fentanyl administered at the time of anesthetic induction. This study shows that the sufentanil, administered at the time of anesthetic induction for laparoscopic cholecystectomy, reduced the need for the use of remifentanil intraoperatively when compared to fentanyl administered at the time of anesthetic induction for laparoscopic cholecystectomy. A potentially better intraoperative analgesia was observed with sufentanil compared to equipotent doses of fentanyl when used at the time to induce anesthesia. There was no statistically significant difference between the groups in relation to pain intensity in the post-anesthesia recovery room and morphine consumption or in relation to possible adverse effects in the post-anesthesia recovery room. Data for each group. In column A is the registration number of each patient. In column B is the group of each patient. Group 1 is the sufentanil group and Group 2 is the fentanyl group. In column C is the dose of remifentanil in micrograms per surgery. In column D is the patient's weight. In column E is the duration of the surgery. In column F is the patient's age. In column G is the sex of each patient. Number 1 is female and number 2 is male. In column H is the ASA physical status of each patient. In column I is the dose of remifentanil in micrograms per patient weight in kilograms in each surgery. In column J is the dose of remifentanil in micrograms per patient weight in kilograms per minute in each surgery. In column K is the patient's pain when awakening from anesthesia. In the L column is the patient's pain after 15 minutes in the post-anesthesia recovery room. In column M is the patient's pain after 30 minutes in the post-anesthesia recovery room. In column N is the patient's pain after 60 minutes in the post-anesthesia recovery room. In column O is the total dose of morphine administered to each patient. In column P is the number of episodes of nausea presented by each patient. In column Q is the number of episodes of vomiting presented by each patient. Column R indicates whether or not the patient had pruritus. The number 1 indicates that the patient had pruritus and the number 0 indicates that the patient did not have pruritus. Column S indicates whether or not the patient presented respiratory depression. The number 1 indicates that the patient had respiratory depression and the number 0 indicates that the patient did not have respiratory depression. Column T shows the sedation presented by each patient. The patient was considered sedated if did not reach score 2 on the Aldrete and Kroulik scale after 30 minutes in the post-anesthesia recovery room. Sedated patients received number 1 in the column and non-sedated patients received number 0 in the column. In column U is the date of data collected.
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Adult patients scheduled for elective laparoscopic cholecystectomy surgery under total venous general anesthesia. The sufentanil group received the opioid sufentanil at a dose of 0.4 µg/kg intravenously at the time of anesthetic induction. The fentanyl group received the opioid fentanyl at a dose of 4 µg/kg intravenously at the time of anesthetic induction. For all groups, anesthesia was induced with lidocaine 1% without vasoconstrictor at the dose 1 mg/kg followed by a controlled target infusion of propofol 1% at a target dose of 4 µg/ml. When the bispectral index reached less than sixty, rocuronium 0.6 mg/kg was administered and endotracheal intubation was performed accompanied by capnography monitoring. Intraoperative anesthetic hypnosis was maintained with an infusion of 1% propofol in a controlled target infusion with a dose at the effector site to maintain the bispectral index (BIS) between 40 and 60. To maintain adequate neuromuscular block for the surgical procedure, an intravenous dose of rocuronium was administered according to TOF parameters. In both groups, continuous infusion of remifentanil at 0.1 µg/kg/min was initiated, if necessary, in the presence of a sustained increase in mean arterial pressure or heart rate of 20% above baseline values. The remifentanil infusion dose was adjusted intraoperatively according to changes in mean arterial pressure and heart rate. When the mean arterial pressure or heart rate exceeded the baseline by 20 per cent, the continuous infusion of remifentanil was increased by 0.1 µg/kg/min. If the mean arterial pressure or heart rate decreased by 20 per cent compared to the baseline, the continuous infusion of remifentanil was reduced by 0.1 µg/kg/min until the mean arterial pressure and heart rate returned to the proposed levels. If a continuous infusion of remifentanil was started, it was discontinued at the conclusion of the surgery. The comparative study was carried out by measuring the total dose of remifentanil used for intraoperative analgesic supplementation as the main outcome. In both groups, dexamethasone 10 mg intravenously and ondansetron hydrochloride 8 mg intravenously were administered in the first hour of surgery. All patients in both groups received analgesia with 100 mg of ketoprofen and 20 mg/kg of dipyrone 30 minutes before the estimated end of the surgery. At the end of the surgery, the surgical incision was infiltrated with 0.5% levobupivacaine. With the patient presenting superficial levels of neuromuscular block according to TOF monitoring parameters, the neuromuscular block was reversed intravenously with sugammadex 2 mg/kg and the tracheal tube removed. If the patient reported pain during their stay in the post-anesthetic recovery room, morphine 0.03 mg/kg was administered, which could be repeated every 10 minutes. When comparing groups, values of p < 0.05 were considered statistically significant.