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

We compared the efficacy and safety of a remifentanil (0.25 mu g.kg(-1).min (-1))-based balanced anaesthetic technique with a bupivacaine-based regiona l anaesthetic technique in an open label, multicenter study in 271 ASA phys ical status 1 or 2 children aged 1-12 years. Subjects requiring major intra -abdominal, urological or orthopaedic surgery were randomly allocated to re ceive either intravenous remifentanil (group R; n = 185) or epidural bupiva caine (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 dist urbance. More children in group R (31%) required interventions to treat hyp otension and/or bradycardia than those in group B (12%), but these were eas ily managed by administration of fluids or anticholinergic drugs. Adverse e vents, 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 mu-opioid receptor agonist. Remifentanil was as effecti ve as epidural or caudal block in providing analgesia and suppressing physi ological responses to surgical stimuli in children aged between 1 and 12 ye ars undergoing major abdominal. urological, or orthopaedic surgery under is oflurane/nitrous oxide anaesthesia.