A MULTICENTER EVALUATION OF REMIFENTANIL FOR EARLY POSTOPERATIVE ANALGESIA

We evaluated the use of an infusion of remifentanil to provide postope rative analgesia during recovery from total intravenous anesthesia (TI VA) with remifentanil and propofol. One hundred fifty-seven patients f rom seven medical centers underwent abdominal, spine, joint replacemen t, or thoracic surgery. Remifentanil was titrated in an effort to limi t pain to 0 or 1 on a 0-3 scale. At the end of the 30-min titration pe riod, 78% of infusion rates were in the range of 0.05 to less than or equal to 0.15 mu g . kg(-1) . min(-1), 5% were <0.05 mu g . kg(-1) min (-1), and 17% were >0.15 mu g . kg(-1) . min(-1). Pain scores were 0 o r 1 in 64% of patients. Nausea occurred in 35% and emesis in 8% of pat ients; the peak incidence of nausea followed discontinuation of the re mifentanil infusion at the time of administering morphine. Respiratory adverse events (oxygen saturation by pulse oximetry [Spo(2)] <90% or respiratory rate <12) affected 29% of patients. Apnea occurred in 11 p atients (7.0%). There was a large variation in the incidence of respir atory depression between the centers, ranging from 0 to 75%. The expla nation for the large variability in respiratory outcome was not eviden t.