Stratification of opioid infusions for head and neck surgery | ||
Degree of postoperative pain | Opioid regimen | |
None to mild | Remifentanil infusion ± fentanyl 1 mcg/kg total dose | |
Mild to moderate | Remifentanil infusion + fentanyl 1 to 3 mcg/kg total dose or Alfentanil infusion | |
Moderate to severe | Sufentanil infusion ± remifentanil infusion* or Fentanyl infusion ± remifentanil infusion* | |
Opioid doses for head and neck surgery¶[1-23] | ||
Opioid | IV load | IV infusion |
Fentanyl | 3 to 7 mcg/kgΔ | 0.7 to 2.5 mcg/kg/hour◊ |
Sufentanil | 0.25 to 1.5 mcg/kgΔ TCI: 0.4 to 0.5 ng/mL | 0.2 to 0.3 mcg/kg/hour TCI: 0.2 to 0.65 ng/mL |
Alfentanil§ | 20 to 40 mcg/kg TCI: 100 to 200 ng/mL | 0.25 to 1.5 mcg/kg/minute TCI: 60 to 150 ng/mL |
Remifentanil | 0.5 to 2 mcg/kg TCI: 4 ng/mL | 0.05 to 0.3 mcg/kg/minute TCI: 1.5 to 9 ng/mL |
IV: intravenous; N2O: nitrous oxide; TCI: target-controlled infusion; TIVA: total IV anesthesia.
* May be additionally required during highly stimulating parts of the surgical procedure.
¶ Assumes: IV induction with propofol 1 to 2 mg/kg, maintenance of TIVA with propofol 80 to 180 mcg/kg/minute (TCI 3 to 5 mcg/mL), and no N2O administration.
Δ We titrate the loading dose of fentanyl or sufentanil using the clinical endpoints during induction, such as either a decrease of respiratory rate or onset of sedation.
◊ Fentanyl infusion should be used with caution and adjusted accordingly due to its long, context-sensitive half-life.
§ Alfentanil is no longer available in the United States or Canada, but remains available in some other countries.Courtesy of Dr. Vladimir Nekhendzy.