Does Fentanyl or Remifentanil Provide Better Postoperative Recovery After Laparoscopic Surgery?

A Randomized Controlled Trial

Ayako Asakura; Takahiro Mihara; Takahisa Goto

Disclosures

BMC Anesthesiol. 2018;18(81) 

In This Article

Results

Seventy subjects were enrolled and randomized into treatment groups, 1 patient discontinued intervention due to the massive blood loss during the surgery; therefore, 69 subjects completed the study (Figure 1). The number of patients analyzed for primary and secondary outcomes are shown in Figure 1. There were no statistically significant differences between the groups in the patients' baseline characteristics, and clinical details (Table 1). No surgical complications, readmissions, or unplanned health care contacts had occurred.

Figure 1.

Consort flow study diagram

The global median (IQR) QoR-40 score presented higher values for the fentanyl group (160[138–177]) compared with the remifentanil group (140[127–166]), however this difference did not reach statistical significance (P = 0.079). Physical comfort and physical independence, the two out of the five dimensions of the QoR-40, demonstrated significantly high scores in the fentanyl group (Table 2). For the eight scales of the SF-36, GH showed a significantly high score in the fentanyl group, but no significant differences existed in the other seven scales (Table 3).

Cortisol was significantly higher in the fentanyl group [group x time, F(3, 201) = 35.6, P < 0.001], and post hoc multiple comparisons test showed that cortisol measured 1 h after the insufflation and at the end of the surgery were significantly higher in the fentanyl group (mean difference [95% CI]: 9.1 [5.0 to 13.1], P < 0.001 and 13.8 [9.7 to 17.8], P < 0.001, respectively). ACTH was also significantly higher in the fentanyl group (F[3, 201] = 6.07, P < 0.001) and post hoc multiple comparisons test determined that ACTH measured 1 h after the insufflation was significantly higher in the fentanyl group (mean difference [95% CI]: 170.2 [84.6 to 255.8], P < 0.001). As for adrenaline, noradrenaline, and dopamine, no significant differences of group existed (F[1, 67] = 0.19, P = 0.66, F[1, 67] = 0.62, P = 0.43, and F[1, 67] = 0.01, P = 0.93, respectively) (Figure 2). The incidences of nausea, vomiting and use of antiemetics assessed 6 and 24 h after surgery showed no significant differences between the groups (Table 4). The pain scores at rest and in motion on 6, 24, and 48 h after surgery, and the total dose of bolus fentanyl using the PCA demonstrated no significant differences between the groups (Table 4). Moreover, the time when the patients started drinking and walking revealed no significant differences between the groups (Table 4).

Figure 2.

Plasma concentration of ACTH (a), cortisol (b), adrenaline (c), noradrenaline (d), and dopamine (e). Time points are before the surgery (1), 1 h after insufflation (2), at the end of the surgery (3), and the next morning (4). Normal ranges of ACTH, cortisol, adrenaline, noradrenaline, and dopamine were 7.2–63.3 pg ml− 1, 6.2–19.4 μg dl− 1, < 100 pg ml− 1, 100–450 pg ml− 1, and < 20 pg ml− 1, respectively. Data are presented as mean ± SD. * P < 0.01

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