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Remifentanil-assisted local anaesthesia: application to continence surgery
Bernard T Haylen1, Steven Katz, Naven Chetty
1St Vincent's Clinic, Darlinghurst, New South Wales, Australia. haylen@optusnet.com.au
Summary
Remifentanil-assisted local anaesthesia (Remi-ALA) offers effective pain relief and patient cooperation for continence procedures. While generally safe, potential side effects like respiratory depression may occur, especially in older patients.
Area of Science:
- Anesthesiology
- Urogynaecology
- Pharmacology
Background:
- Tension-free vaginal tapes and similar procedures are common in urogynaecology.
- Effective local anaesthesia and patient cooperation are crucial for these procedures.
Purpose of the Study:
- To evaluate the efficacy and safety of remifentanil-assisted local anaesthesia (Remi-ALA) for continence procedures.
Main Methods:
- Remifentanil, an ultrarapid-acting opioid, administered via intravenous infusion.
- Typically combined with a sedative/amnesic (e.g., midazolam) and local anaesthesia.
- Utilized for tension-free vaginal tape procedures.
Main Results:
- Remi-ALA provides excellent analgesia for local anaesthetic injections and tape insertion.
- Ensures optimal patient cooperation, facilitating procedures like post-insertion cough testing.
- Potential side effects include dose-related respiratory depression and bradycardia.
Conclusions:
- Remi-ALA is an effective assisted local anaesthetic technique for urogynaecological continence procedures.
- Particular caution is advised for older women (over 70) due to increased risk of side effects.
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