Comparison of Postoperative Pain Application of Alfentanil or Remifentanil in TIVA
Condition: Postoperative Pain
MeSH terms: Pain, Postoperative
Study type: Interventional
Phase: Phase 4

Summary: 
      Total intravenous anesthesia (TIVA) is maintained by intermittent or continuous combined
      intravenous injection of a variety of short-acting intravenous anesthetics, which can provide
      safe and rapid induction, maintenance and termination of general anesthesia. It has a slight
      effect on respiration and circulation, strong controllability, short anesthetic recovery
      time, reduced postoperative nausea and vomiting (PONV) and quick discharge time, so it has
      been widely used in clinic. Functional endoscopic sinus surgery is a common method for the
      treatment of sinusitis and other diseases. The trauma of this operation is less. The use of
      TIVA during the operation can reduce the bleeding in the surgical field and is beneficial to
      the recovery of patients.

      The combination of propofol and remifentanil is the most common in TIVA because of its fast
      pharmacokinetics and short half-life. However, the disadvantage of remifentanil is the lack
      of residual analgesic effect after termination of continuous infusion. As postoperative nasal
      packing can still bring postoperative pain, patients with severe discomfort caused by pain
      will have unexpected conditions such as surgical incision cracking and bleeding, which will
      affect the effect of operation and rehabilitation. Afentanil is another opioid drug with
      short effect and strong analgesic effect. Previous studies have shown that remifentanil-based
      TIVA has slightly higher postoperative pain and early use of analgesics than TIVA in
      discectomy. Because the effect of TIVA using Afentanil or remifentanil on postoperative pain
      in functional nasal endoscopic surgery is not clear, this study intends to observe the effect
      of TIVA on postoperative pain in patients undergoing functional nasal endoscopic surgery
      under general anesthesia, so as to optimize the clinical anesthetic scheme of this kind of
      minimally invasive surgery and provide clinical reference.
    

Detailed description: 
      This study intends to observe the effect of TIVA using afentanil or remifentanil on
      postoperative pain in patients undergoing functional nasal endoscopic surgery under general
      anesthesia.

      Main indicators:

      VAS score at 30 min after operation.

      Secondary indicators:

      VAS score of 60 min after operation. VAS score of 24h after operation. Number of cases of
      postoperative use of analgesics . Number of cases of postoperative adverse reactions.
    

Intervention name(s): Propofol combined with alfentanil; Propofol combined with remifentanil
Intervention type(s): Drug; Drug
Intervention description(s): Anesthesia induction: midazolam 0.02 mg/kg, propofol（TCI） 3 μ g/mL, alfentanil 20 μ g/kg and rocuronium 0.6 mg/kg . Anesthesia maintenance: target-controlled infusion of propofol combined with alfentanil(0.5-2ug/kg/min); Anesthesia induction: midazolam 0.02 mg/kg, propofol（TCI） 3 μ g/mL, remifentanil 1μ g/kg and rocuronium 0.6 mg/kg . Anesthesia maintenance: target-controlled infusion of propofol combined with remifentanil(0.1-0.3ug/kg/min)
Intervention MeSH terms: Remifentanil; Alfentanil; Propofol
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: functional endoscopic sinus surgery; postoperative pain; afentanil or remifentanil