ABSTRACT

Sedation is widely used with local anesthesia in daycase surgery. In this study we aimed to compare the effects of tramadol-midazolam (Group T-M) and remifentanyl (Group R) combined with local anesthesia for sedation in pilonidal sinus surgery.

After approval by the Instutional Ethics Committee and receival of informed written consent forms, 81 patients (ASA I,II), aged 17-64 years undergoing pilonidal sinus operation were enrolled in the study. In the preoperative period patients received one of two treatment regimens: Remifentanyl 1 µg kg-1 given over 30 sec followed by a continuous infusion of 0.05 µg kg-1 min-1 (Group R) or tramadol 100 mg followed by continuous infusion of midazolam 0.1 mg kg-1 h-1 (Group T-M). Surgery started after local anesthetic (1/200.000 adrenalin-15 mL prilocaine) injection. Hemodynamic, respiratory and other measurements (VAS, Ramsey, Aldrete score) were performed at specified times until the end of surgery. The amount of intraoperative additional analgesic, time to the first postoperative analgesic requirement, and patient-surgeon satisfaction were evaluated. Remifentanyl 0.5 µg kg-1 to Group R and 50 mg tramadol to Group T-M were given when VAS>4.

MAP in Group T-M was significantly lower than Group R at 30th min (p=0.01). MAP values were similar between both groups at other time points. Ramsey sedation score was higher at 1st and 5th min in Group R but this score was similar in other time points between the groups. Also HR, MAP, SPO2 , respiratory rate, Aldrete Recovery Score, time to the first requirement for an analgesic, and discharge time were similar for both groups. Additional analgesic was given to 19 patients in Group T-M and 6 patients in Group R (pİ0.01).

In this study we provided early sedation and better analgesia with remifentanyl. The haemodynamic changes related to the combination of tramadol-midazolam should be carefully considered at patients with risk.

Keywords: sedation, remifentanyl, tramadol, midazolam