Patient-controlled sedation using remifentanil for third molar extraction

The purpose for this study was to examine the efficacy of patient-controlled sedation (PCS) with remifentanil as an intravenous adjunct to local anaesthesia for treating pain associated with dental extraction during monitored anaesthetic care. Forty ASA 1-2 and aged 18 or older Chinese patients presenting for third molar extraction on an outpatient basis were randomly assigned to either remifentanil (RG; n =20) or saline groups (CG; n =20). All patients completed the study. Patients in the RG and CG were comparable in terms of demographic variables, PCS demands and PCS boluses. There was high variability of PCS among patients in both groups in terms of demands (range for RG 0-62; CG 0-41) and consumption (range for RG 0-26; CG 0-13). Neither group required any rescue local anaesthetic injection for pain or midazolam for anxiety. There was no clinically relevant differences in outcome measures (pain scores, anxiety scores, systolic and diastolic blood pressures, heart rate, and SpO2) between the two groups. There were no other major complications such as apnoea, desaturation, bradycardia, or chest wall rigidity in either group. We conclude that, although it appeared to be safe, the addition of patient-controlled remifentanil was not a useful adjunct to local anaesthesia for pain associated with third molar dental extraction.