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BJA Advance Access originally published online on July 2, 2007
British Journal of Anaesthesia 2007 99(3):404-411; doi:10.1093/bja/aem164
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Influence of intraoperative opioid on postoperative pain and pulmonary function after laparoscopic gastric banding: remifentanil TCI vs sufentanil TCI in morbid obesity {dagger}

L. E. C. De Baerdemaeker1,*, S. Jacobs1, P. Pattyn2, E. P. Mortier1 and M. M. R. F. Struys1

1 Department of Anaesthesia
2 Department of Surgery, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium

* Corresponding author: Department of Anaesthesia, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium. E-mail: luc.debaerdemaeker{at}ugent.be

Background: Choice of opioid may influence postoperative pain, recovery, and respiratory homeostasis in morbid obesity. The aim of this study was to compare the effects of target-controlled infusions (TCIs) of remifentanil or sufentanil on postoperative analgesia, recovery, and pulmonary function after laparoscopic gastric banding.

Methods: Forty morbidly obese patients undergoing laparoscopic gastric banding received BIS-guided desflurane anaesthesia combined with remifentanil TCI (Group R) or sufentanil TCI (Group S). Intraoperative haemodynamic stability, BIS controllability, and immediate recovery in the operating room were measured. Pulmonary function, modified Aldrete score, modified Observers Assessment of Alertness and Sedation score, blood gas analysis, and visual analogue score for pain and postoperative nausea and vomiting were measured on admission to the post-anaesthesia care unit and 30, 60, 120 min afterwards. After operation, patients received patient-controlled analgesia with morphine.

Results: During the first two postoperative hours, cumulative morphine consumption was higher in the remifentanil group compared with the sufentanil group, but was equal values after that time. Recovery profiles and spirometry showed no significant differences. During maintenance, remifentanil gave a better haemodynamic stability.

Conclusions: As few differences occurred in the postoperative period, the theoretical advantage of remifentanil over the longer acting sufentanil can be questioned when using TCI technology.

Keywords: analgesia, anaesthetic analgesic regimens; drug delivery, computerized; lung, respiratory function; pharmacokinetics, obesity; recovery

{dagger} Performed at the Department of Anaesthesia, University Hospital of Ghent, Ghent, Belgium.


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