Safety and effectiveness of analgesia with remifentanil for percutaneous transhepatic biliary drainage.

Objective: The purpose of this study was to evaluate the safety and effectiveness of analgesia with remifentanil for percutaneous transhepatic biliary drainage.

Subjects And Methods: Analgesia for percutaneous transhepatic biliary drainage was induced with remifentanil in 186 patients over a 1-year period. Remifentanil was administered IV with an infusion pump at 0.1 microg/kg/min as the usual dose and 0.15 microg/kg/min as the maximal dose. Selected patients with severe anxiety also received a 1-mg bolus of midazolam. Vital signs, sedation levels, and side effects were checked every 5 minutes during the procedure and recovery. The patients scored their pain subjectively on an 11-point numerical rating scale.

Results: The mean total dose of remifentanil was 116.3 microg (range, 32.5-200 microg). Midazolam was administered to 15 patients. Transient bradycardia occurred in 19 patients (10%). Hypotension did not develop in any patient. Respiratory depression occurred in four patients (2%). An appropriate level of sedation was obtained in 182 patients (98%), the modified Ramsay score being 2 (n = 164, 88%) or 3 (n = 18, 10%). Forty-nine of the patients (26%) indicated no pain (numeric rating, 0), 120 (64%) indicated mild pain (numeric rating, 1-3), and 16 (9%) indicated moderate pain (numeric rating, 4-6). One patient (1%) indicated severe pain (numeric rating, 7).

Conclusion: Remifentanil is safe and highly effective for pain control during percutaneous transhepatic biliary drainage. This drug is a suitable option for analgesia during painful interventional radiology procedures.