Akça, Başak Hacettepe University - School of Medicine - Department of Anesthesiology and Reanimation, Turkey , Yılbaş, Aysun Ankay Hacettepe University - School of Medicine - Department of Anesthesiology and Reanimation, Turkey , Çelebi, Nalan Reanimation Hacettepe University - School of Medicine - Department of Anesthesiology, Turkey

Intravenous acetaminophen in combination with remifentanil / nitrous oxide on posttonsillectomy nausea-vomiting and pain in children-a randomised controlled trial

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Objective: Many anesthesiologists have quit using nitrous oxide in their daily practice because of its side effects and also the introduction of short-acting opioids such as remifentanil. Our aim is to compare the effects of intraoperative remifentanil vs nitrous oxide in combination with iv acetaminophen on post-tonsillectomy pain in children Method: Sixty-eight, pediatric patients undergoing adenonsillectomy operations were randomized into two groups of thirty-four each. General anaesthesia was induced by inhalation of sevoflurane (8%) in both groups. The nitrous oxide group (group I) received sevoflurane at an end-tidal conentration of 1.5-2, delivered with 70% nitrous oxide in oxygen. The remifentanil group (group II) also received sevoflurane in the same way but delivered in an oxygen-air gas mixture. Group II also received an intravenous (i.v.) infusion of remifentanil at 0.1-0.3 μg/kg^-1 min^-1. Both of the groups received i.v. acetaminophen infusions before surgical incision. Pain scores in the PACU and during the first 24 h were assessed. Results: Demographics were similar among the groups. Twenty three patients in group I and 7 patients in group II have required rescue analgesia and time to first analgesia was longer in group II. Thirty-three (97.1%) patients in group I and 20 (58.8%) patients in group II needed analgesics at home. Pain scores in the PACU and at 24. hr were significantly lower in group II. Conclusion: Combination of i.v. acetaminophen with remifentanil rather than nitrous oxide seems to be more suitable for outpatient adenotonsillectomy operation.

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Remifentanil , nitrous oxide , adenotonsillectomy surgery , pediatric anesthesia

Cumhuriyet Medical Journal

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