Patient-maintained analgesia with target-controlled alfentanil infusion after cardiac surgery: a comparison with morphine PCA.

The performance of a patient-demand, target-controlled alfentanil infusion system was compared with that of a traditional morphine patient-controlled analgesia (PCA) pump in 120 adult patients after cardiac surgery. Patients were randomized to one of the two PCA systems for their postoperative analgesia in the intensive care unit and pain, nausea and sedation scores were recorded every 4 h for the first 24 h. Episodes of hypoxaemia, myocardial ischaemia and haemodynamic instability were also recorded. In patients using the alfentanil system the overall median visual analogue pain score was 2.3 (95% Cl 2.3-2.8) compared with 3.0 (95% Cl 2.7-3.2) in those using morphine PCA (P < 0.05), but both systems delivered high-quality analgesia. The two groups did not differ with respect to the overall sedation scores, the frequency of postoperative nausea and vomiting, haemodynamic instability, myocardial ischaemia or hypoxaemia.

[1]  W. Browner,et al.  Perioperative myocardial ischemia: importance of the preoperative ischemic pattern. , 1988 .

[2]  W. Browner,et al.  Postoperative Myocardial Ischemia: Therapeutic Trials Using Intensive Analgesia Following Surgery , 1992 .

[3]  R. Cartier,et al.  Hydromorphone patient-controlled analgesia (PCA) after coronary artery bypass surgery , 1994, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[4]  A. Harrop‐Griffiths,et al.  Postoperative pain. Expectation and experience after coronary artery bypass grafting. , 1996, Anaesthesia.

[5]  B K Philip,et al.  Parametric statistics for evaluation of the visual analog scale. , 1990, Anesthesia and analgesia.

[6]  P. Joachimsson,et al.  Early extubation after coronary artery surgery in efficiently rewarmed patients: a postoperative comparison of opioid anesthesia versus inhalational anesthesia and thoracic epidural analgesia. , 1989, Journal of cardiothoracic anesthesia.

[7]  N. Morton,et al.  Pharmacokinetic model driven infusion of propofol in children. , 1991, British journal of anaesthesia.

[8]  R C Smith,et al.  Postoperative myocardial ischemia in patients undergoing coronary artery bypass graft surgery. S.P.I. Research Group. , 1991, Anesthesiology.

[9]  L. Way,et al.  Long-term cardiac prognosis following noncardiac surgery , 1992 .

[10]  W. Browner,et al.  Long-term cardiac prognosis following noncardiac surgery. The Study of Perioperative Ischemia Research Group. , 1992, JAMA.

[11]  M. Gielen,et al.  Coronary artery bypass grafting using two different anesthetic techniques: Part 2: Postoperative outcome. , 1992, Journal of cardiothoracic and vascular anesthesia.

[12]  J. Heykants,et al.  Plasma protein binding and distribution of fentanyl, sufentanil, alfentanil and lofentanil in blood. , 1982, Archives internationales de pharmacodynamie et de therapie.

[13]  M. White,et al.  Postoperative analgesia using a computerised infusion of alfentanil following aortic bifurcation graft surgery , 1992, International journal of clinical monitoring and computing.

[14]  M F Roizen,et al.  A proposal to use confidence intervals for visual analog scale data for pain measurement to determine clinical significance. , 1993, Anesthesia and analgesia.

[15]  M. Goldin,et al.  Continuous epidural infusion of morphine for pain relief after cardiac operations. , 1987, The Journal of thoracic and cardiovascular surgery.

[16]  C. Chapman,et al.  Profiles of opioid analgesia in humans after intravenous bolus administration: alfentanil, fentanyl and morphine compared on experimental pain , 1990, Pain.

[17]  P. Myles,et al.  Comparison of Patient-Controlled Analgesia and Nurse-Controlled Infusion Analgesia after Cardiac Surgery , 1994, Anaesthesia and intensive care.