Comparison of remifentanil versus regional anaesthesia in children anaesthetised with isoflurane/nitrous oxide

✍ Scribed by C. Prys-Roberts; J. Lerman; I. Murat; T. Taivainen; T. Lopez; C. Lejus; I. Spahr-Schopfer; W. Splinter; A. J. T. Kirkham

• Publisher: John Wiley and Sons
• Year: 2000
• Tongue: English
• Weight: 112 KB
• Volume: 55
• Category: Article
• ISSN: 0003-2409
• DOI: 10.1046/j.1365-2044.2000.01607.x

✦ Synopsis

We compared the efficacy and safety of a remifentanil (0.25 µg.kg^−1^.min^−1^)‐based balanced anaesthetic technique with a bupivacaine‐based regional anaesthetic technique in an open label, multicentre study in 271 ASA physical status 1 or 2 children aged 1–12 years. Subjects requiring major intra‐abdominal, urological or orthopaedic surgery were randomly allocated to receive either intravenous remifentanil (group R; n = 185) or epidural bupivacaine (group B; n = 86) with isoflurane/nitrous oxide for their anaesthesia. The majority of children in both groups (85% in group R, 78% in group B) showed no defined response to skin incision, and although the mean increase in systolic blood pressure (+11 mmHg) was significantly greater in group R than in group B, this change did not represent a serious haemodynamic disturbance. More children in group R (31%) required interventions to treat hypotension and/or bradycardia than those in group B (12%), but these were easily managed by administration of fluids or anticholinergic drugs. Adverse events, mainly nausea and/or vomiting, occurred in 45% of group R and 42% of group B (NS). The adverse event profile of remifentanil in this study was typical of a potent µ‐opioid receptor agonist. Remifentanil was as effective as epidural or caudal block in providing analgesia and suppressing physiological responses to surgical stimuli in children aged between 1 and 12 years undergoing major abdominal, urological, or orthopaedic surgery under isoflurane/nitrous oxide anaesthesia.