Comparison of alfentanil and fentanyl for anesthesia in short gynecologic procedures

Alfentanil hydrochloride, a rapid onset opioid analgesic with a short duration of action has recently become available in Taiwan. Its properties portend wide usage in outpatients who require rapid recovery of physical and mental function. Fentanyl, a well-established drug with basic pharmacologic properties similar to those of alfentanil, was used as a reference drug in this study of alfentanil hydrochloride. We studied 50 clinically evaluable patients who underwent gynecologic surgery and randomly divided them into two groups. Twenty-five patients received alfentanil and 25 received fentanyl. The hemodynamic and respiratory status of each patient was monitored during the pre-, intra- and postoperative periods. Recovery from anesthesia was evaluated by the time to emergence from anesthesia, the time to first postoperative analgesic, the objective pain-discomfort scale, the modified Aldrete score and the visual analog scales (VAS) recovery score. Digit symbol substitution test (DSST) and Trieger dot tests were used to assess psychomotor function in the recovery period as well. We found that alfentanil, as a major analgesic agent in total intravenous anesthesia (TIVA) for short gynecologic procedures, has better cardiovascular stability, a shorter time to emergence from anesthesia, a higher VAS recovery score and a better performance in the DSST test than fentanyl. For short gynecologic procedures, alfentanil appears to be superior to fentanyl, especially for recovery of psychomotor function.