Pediatric Pain Relief in Laparoscopic Surgery: Study Unravels Anesthetic Dilemma
Recent Investigation into the effects of varying doses of remifentanil combined with sevoflurane anesthesia on postoperative analgesia and hemodynamics in pediatric patients undergoing laparoscopic inguinal hernia repair was conducted through a randomized, double-blind controlled trial involving 310 children aged 2-8 years. The final sample consisted of 280 patients, randomly allocated into four groups: a control group receiving sevoflurane, and three treatment groups receiving low (0.10 µg/kg), medium (0.20 µg/kg), and high (0.25 µg/kg) doses of remifentanil alongside sevoflurane.
All patients were preconditioned with atropine and administered propofol, followed by muscle relaxants. Depending on age, intubation or laryngeal masks were used.
- -*-*Anesthesia Maintenance-*-*: The control group had sevoflurane administered alone; the intervention groups received their respective doses of remifentanil in addition to sevoflurane adjustments.
- -*-*Outcome Measures-*-*: Primary outcomes measured included the Behavioral Pain Scale (BPS) for analgesia and the Ramsay Sedation Scale (RSS) for sedation at multiple postoperative time points (1-12 hours). Secondary evaluations included Pediatric Anesthesia Emergence Delirium (PAED) scores and hemodynamic stability (mean arterial pressure, heart rate, SpO2).
### Key Results - -*-*Analgesia and Sedation-*-*: The BPS scores were significantly lower in the treatment groups compared to the control, with a dose-dependent reduction particularly noted in the high-dose group. The area under the curve (AUC) for BPS also decreased with increasing remifentanil doses. RSS scores indicated greater sedation as remifentanil dose increased.
- -*-*Hemodynamics-*-*: The mean arterial pressure and heart rate remained more stable in the remifentanil groups versus the control, which showed greater fluctuations. SpO2 remained stable across all groups.
- -*-*Adverse Reactions-*-*: The incidence of adverse effects like nausea and vomiting did not significantly differ across lower doses but was markedly reduced in the high-dose group compared to controls. ### Limitations - Small sample size and restriction to a narrow age range may affect generalizability. Lack of analysis on inflammatory factors and postoperative recovery time are noted gaps. Additionally, the potential impact of escalating opioid doses on vomiting wasn't explored. Statistical techniques could have been enhanced by using a multilevel model approach to strengthen findings.
These findings propose that using remifentanil in conjunction with sevoflurane anesthesia enhances postoperative analgesia and hemodynamic stability in pediatric patients undergoing laparoscopic surgery, with 0.25 µg/kg showcasing the most benefits.
Key Points
- A randomized, double-blind controlled trial with 280 pediatric patients aged 2-8 years was conducted to assess the effects of varying doses of remifentanil (0.10, 0.20, and 0.25 µg/kg) combined with sevoflurane on analgesia and hemodynamics during laparoscopic inguinal hernia repair.
- Anesthesia induction involved the administration of atropine and propofol, with subsequent intubation or use of laryngeal masks based on patient age, followed by sevoflurane maintenance alone for the control group and with remifentanil for treatment groups.
- Primary outcome measures included the Behavioral Pain Scale (BPS) and Ramsay Sedation Scale (RSS), assessed at multiple postoperative time points (1-12 hours), while secondary measures encompassed Pediatric Anesthesia Emergence Delirium (PAED) scores and hemodynamic parameters like mean arterial pressure and heart rate.
- Results indicated that treatment groups had significantly lower BPS scores, particularly in the high-dose group, with a clear dose-dependent relationship. Increased remifentanil doses were associated with elevated RSS scores, suggesting greater sedation.
- Hemodynamic stability was superior in the remifentanil groups compared to the control, with more consistent mean arterial pressure and heart rates. Oxygen saturation (SpO2) levels remained stable across all groups.
- While adverse reactions such as nausea and vomiting did not show a significant variance among lower remifentanil doses, a notable reduction in these events occurred in the high-dose group compared to controls, hinting at enhanced tolerability of higher remifentanil doses.
Reference –
Jinben Ma et al. (2025). Effects Of Different Doses Of Remifentanil Combined With Sevoflurane Anesthesia On Postoperative Analgesia And Hemodynamics In Pediatric Patients Undergoing Laparoscopic Inguinal Hernia Repair. *BMC Anesthesiology*, 25. https://doi.org/10.1186/s12871-025-03104-z.
