Original ContributionRemifentanil versus fentanyl in total intravenous anesthesia for lumbar spine surgery: a retrospective cohort study☆
Introduction
Lumbar spinal surgery is the most frequently performed type of neurological surgery [1]. Given the elective nature and predictable surgical course of this type of procedure, operating schedules are usually busy, and short turnover times are required for optimized operating room use. Operating room efficiency is governed by a number of factors, two of which are anesthesia-controlled time and turnover time. Anesthetic techniques providing fast emergence from anesthesia after the completion of surgery may contribute to the shortening of anesthesia-controlled time [2].
Total intravenous anesthesia (TIVA) incorporating the combined use of propofol and remifentanil has been shown to provide faster emergence than other anesthetic techniques [3]. However, it remains debatable whether the time savings observed in some controlled clinical studies translates into clinically relevant benefits [4].
A modification of our departmental anesthetic approach to lumbar spine surgery was prompted by an awareness of the lack of evidence for the superiority of remifentanil-propofol TIVA (REMI-TIVA) over fentanyl-propofol TIVA (FENT-TIVA) [3]. This shift offered an opportunity to study the efficacy of remifentanil infusion versus fentanyl boluses as part of a TIVA regimen for elective lumbar spine surgery. To this end, we conducted a retrospective cohort study of patients who underwent lumbar vertebral disc surgery before and after the changeover from one anesthetic regimen to the other. The following parameters were evaluated: (a) total duration of anesthesia relative to surgical duration, (b) time to emergence from anesthesia after the completion of surgery, (c) length of stay in the postanesthesia care unit (PACU), and (d) requirements for opioid analgesia, nonopioid analgesia, and antiemetics in the perioperative period.
Section snippets
Patient selection
Patients who underwent lumbar vertebral disc surgery from July 2008 to September 2008, when remifentanil was routinely used as part of the anesthetic regimen, were compared with an identical number of consecutive patients from a period commencing in July 2009, when fentanyl was part of the routine anesthetic regimen. Inclusion criteria were recorded International Classification of Diseases code M51 (“other intervertebral disc disorders”) [5] and all of the following procedural codes: “surgical
Results
One hundred six patients (53 per group) were studied. There were no statistically significant differences in patient demographics (Table 1). Surgical times were significantly longer in the FENT-TIVA group, but anesthesia times were not. There were no differences between the remifentanil and fentanyl groups with regard to emergence times and PACU times (Table 2).
The relationship between surgery times and anesthesia times was evaluated by regression analysis for both groups. The coefficients of
Discussion
The main finding of this study was that FENT-TIVA and REMI-TIVA were equivalent in terms of anesthesia time, the speed of emergence from anesthesia, and the subsequent length of stay in the PACU. Anesthesia time correlated with surgery time for both agents. Pain control was inferior in patients who received REMI-TIVA, but the use of antiemetics did not differ between the two types of TIVA.
Numerous studies comparing remifentanil with other opioids as part of a general anesthesia have been
Conclusions
Remifentanil-propofol TIVA and FENT-TIVA are equally efficient for lumbar disc surgery, but the use of remifentanil requires increased perioperative analgesic use.
References (17)
The post-anesthesia recovery score revisited
J Clin Anesth
(1995)- et al.
Recovery and cognitive function after fentanyl or remifentanil administration for carotid endarterectomy
J Clin Anesth
(2005) - et al.
Hemodynamics and emergence profile of remifentanil versus fentanyl prospectively compared in a large population of surgical patients
J Clin Anesth
(2001) - et al.
Comparison of remifentanil with fentanyl for deep sedation in oral surgery
J Oral Maxillofac Surg
(2006) - et al.
Comparability between the rates for all-listed inpatient procedures using National Hospital Discharge Survey and Medicare claims, 1999 and 2007
(2012) - et al.
Process analysis in outpatient knee surgery
Anesthesiology
(2000) - et al.
Remifentanil for general anaesthesia: a systematic review
Anaesthesia
(2007) Impact on operating room efficiency of reducing turnover times and anaesthesia-controlled times
Ann Surg
(2007)
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Disclosures and conflict of interest: none declared.