Postoperative pain control following remifentanil-based anaesthesia for major abdominal surgery

Eighty patients undergoing major abdominal surgery using remifentanil-based anaesthesia were randomly allocated in a double-blind manner to receive an intravenous bolus of fentanyl, buprenorphine, morphine or piritramide 20 m in before the end of surgery. A reduced dose was administered postoperative ly when patients reported moderate pain. Subsequent analgesia was provided by patient-controlled analgesia (PCA). The mean time from the end of anaest hesia to spontaneous respiration was 9 +/- 5 min. At first pain assessment, 63% of patients reported no or mild pain; 80% of patients required the sec ond opioid bolus, those receiving piritramide needed the bolus significantl y later than patients receiving buprenorphine or fentanyl. First PCA requir ement also occurred significantly later in the piritramide group. This tech nique provided effective postoperative pain relief and transition to routin e PCA and did not compromise recovery.