Effects of Fentanyl and Remifentanil on intraoperative hemodynamics and postoperative recovery in percutaneous nephrolithotomy cases

Abstract

Objective: To compare the effects of fentanyl or remifentanil on intraoperative hemodynamic effects and postoperative recovery in patients undergoing percutaneous nephrolithotomy (PCNL).Material and Methods: Randomized and prospective study was conducted. Forty patients who underwent PCNL with the American Society of Anaesthesiologists (ASA) I-II enrolled into the study. All patients were divided into 2 groups according to administered anaesthesiology technique and drugs, which are remifentanil and fentanyl. Induction of anesthesia was same in both groups. Induction of anesthesia was obtained with a bolus dose of propofol (1-2 mg/kg), maintenance was achieved with sevoflurane (MAC2). Muscle relaxation was achieved with rocuronium. Group 1 was consisted of patients who were administered remifentanil and they received 1 μgr/kg of remifentanil as a single dose during the induction of anaesthesia Group 2 was received fentanyl 2 μg/kg as a single dose during the induction of anaesthesia. Group 1 received remifentanil 0.05 μgr/kg per minute as an infusion throughout the procedure for providing intraoperative hemodynamic stability, in group 2 fentanyl was given at a dose of 0.5 μg/kg iv bolus every 45 minutes. Intraoperative hemodynamic parameters and recovery data were recorded. Aldrete score, Ramsay sedation scale 15, 60, 360 minutes were noted after surgery. Visual analogue scale (VAS0-10) was used for pain evaluation.Results: Intraoperative hemodynamic measurements were more stable in Group 1. The need for nitro-glycerine was significantly increased in Group 2 (p<0.05). The Aldrete scores, Ramsay sedation scales and VAS did not differ significantly between the groups. Immediate recovery was significiantly earlier in Group 1 than Group 2 (p<0.05).Conclusion: Stable hemodynamic status and safer recovery can be provided with remifentanil compared to fentanyl during PCNL.