TRANSITION TO POSTOPERATIVE EPIDURAL OR PATIENT-CONTROLLED INTRAVENOUS ANALGESIA FOLLOWING TOTAL INTRAVENOUS ANESTHESIA WITH REMIFENTANIL AND PROPOFOL FOR ABDOMINAL-SURGERY

Remifentanil is an ultrashort acting mu opioid, well suited to total i ntravenous (i.v.) anaesthesia. Pain immediately following emergence fr om anaesthesia is a potential problem because of the rapid offset. Thi s study investigated the transition from remifentanil/propofol total i ntravenous anaesthesia to post-operative analgesia with epidural oh pa tient controlled analgesia morphine in 22 patients undergoing major ab dominal surgery. A remifentanil post-operative infusion initiated duri ng emergence was titrated in the recovery room for 30 min, at which ti me 14% of patients had a pain score of 2 and 86% had pain scores of 0 or 1 (0 = no pain; 1 = mild pain; 2 = moderate pain; 3 = severe pain), at a mean infusion rate of 0.086 mu g kg(-1) min(-1). a smooth transi tion was then made to either epidural analgesia or patient controlled analgesia with morphine; pain scores were not significantly changed du ring the transition. Nausea occurred in 16 of the 22 patients, but onl y following administration of morphine. Epidural analgesia produced si gnificantly lower pain scores on the surgical ward compared with patie nt controlled analgesia.