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 μg/kg/min as the usual dose and 0.15 μg/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 μg (range, 32.5-200 μg). 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.