Remifentanil의 목표농도조절주입을 이용한 propofol 정주통의 경감

Abstract

Background: Propofol has a high incidence of infusion pain. Wehypothesized that propofol infusion pain might be prevented byinfusing remifentanil before starting the propofol infusion in a clinicalsetting where target controlled infusions (TCI) of both drugs wereused. We compared the efficacy of remifentanil TCI administered90 seconds before propofol TCI with remifentanil TCI and propofolTCI given immediately after a 40 mg lidocaine bolus in preventionof propofol infusion pain. Methods: One hundred sixty five ASA 1 or 2 patients scheduledfor elective surgery under general anesthesia were classified inthree groups. Group C: propofol TCI and remifentanil TCI wasstarted at the same time (n = 55), group L: lidocaine 40 mg injectionimmediately prior to propofol TCI and remifentanil TCI (n = 55),group R: remifentanil TCI was started 90 seconds before propofolTCI (n = 55). Pain severity of propofol infusion was evaluated usinga four-point scale (none, mild, moderate, severe). Results: The incidence of pain in group R and group L wassignificantly lower than in group C. There was no significantdifference between group R and group L. But the incidence ofmoderate and severe pain in group R was significantly lower thanin group L (P ＜ 0.05). Conclusions: Remifentanil TCI 90 seconds before propofol TCIreduces propofol infusion pain than propofol TCI and remifentanilTCI started at the same time. This protocol is considered to be moreeffective in alleviating moderate and severe pain than lidocaine.