Development of Acute Opioid Tolerance During Infusion of Remifentanil for Pediatric Scoliosis Surgery

Crawford, Mark W.; Hickey, Chantal; Zaarour, Christian; Howard, Andrew; Naser, Basem

doi:10.1213/01.ane.0000216036.95705.c2

Cited by 162 publications

(92 citation statements)

References 25 publications

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“…The sample size estimation was based on a study from this institution demonstrating that the initial 24-hr morphine consumption after surgery for idiopathic scoliosis was 1.65 mg.kg -1 + 0.41 mg.kgq. 3 To demonstrate a 25% difference in 24-hr morphine consumption (0.41 mg.kg-~), we estimated that 18 patients per group were required for a two-tailed (x of 0.05 and a tg of 0.2 (power = 80%). Forty patients were recruited to accommodate any potential protocol violations or dropouts.…”

Section: Discussionmentioning

confidence: 99%

“…Intraoperative infusion of remifentanil was associated with the development of hyperalgesia manifesting clinically as an increase in postoperative morphine consumption. 3,4 The increase in postoperative morphine consumption was variable, ranging fi:om 30% to 100% for comparable durations of remifentanil infusion. 3,4 One explanation offered for the observed differences in postoperative opioid consumption between these studies was that morphine administered at induction of anesthesia may have had a preemptive analgesic effect, thereby attenuating the development of remifentanil-induced acute opioid tolerance.…”

Section: Discussionmentioning

confidence: 99%

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Pre-treatment with morphine does not prevent the development of remifentanil-induced hyperalgesia

McDonnell

Zaarour

Hull

et al. 2008

Can J Anesth/J Can Anesth

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Purpose:Remifentanil, an ultra short-acting opioid commonly used to supplement general anesthesia, is associated with the development of hyperalgesia that manifests clinically as an increase in postoperative analgesic requirement. This study involving adolescents undergoing scoliosis surgery evaluated whether pre-treatment with morphine prior to commencing remifentanil infusion would decrease the initial 24-hr morphine consumption and pain scores.Methods: Forty ASA I-II pediatric patients undergoing surgical correction of idiopathic scoliosis were recruited in a prospective, randomized, double-blind fashion to receive 150/ag-kg -r morphine or an equal volume saline prior to commencing remifentanil by infusion. The primary outcome was the initial 24-hr postoperative morphine consumption. Numeric rating scale (NRS) pain scores at rest and on coughing were recorded, as were scores for nausea, vomiting, and sedation and incidences of pruritus. Results:The groups were demographically similar. No differences were observed between groups vis-a-vis the initial 24-hr morphine consumption, NRS pain scores, sedation, nausea, or vomiting.Conclusion: Pre-treatment with 150/ag-kg -~ morphine did not decrease the initial 24-hr morphine consumption in adolescents who received remifentanil by infusion for surgical correction of idiopathic scoliosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pre-treatment with morphine does not prevent the development of remifentanil-induced hyperalgesia

McDonnell

Zaarour

Hull

et al. 2008

Can J Anesth/J Can Anesth

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“…Postoperative PCA morphine requirements in children with sickle-cell disease were almost double those of nonsickle children (Crawford, Galton et al, 2006 Level III-3). Intraoperative remifentanil was associated with an increase in PCA morphine requirement in the 24 hours following scoliosis surgery (Crawford, Hickey et al, 2006 Level II), possibly due to acute opioid-induced hyperalgesia.…”

Section: Efficacymentioning

confidence: 99%

Safety of opioid patch initiation in Australian residential aged care

Gadzhanova

Roughead

Pont

2015

Medical Journal of Australia

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Objective: To explore opioid use by aged care facility residents before and after initiation of transdermal opioid patches. Design: A cross‐sectional cohort study, analysing pharmacy data on individual patient supply between 1 July 2008 and 30 September 2013. Setting: Sixty residential aged care facilities in New South Wales. Participants: Residents receiving an initial opioid patch during the study period. Main outcome measure: The proportion of residents who were opioid‐naive in the 4 weeks prior to patch initiation was determined. In addition, the patch strength at initiation and the daily dose of transdermal patches and of additional opioids 1 month after initiation were determined. Results: An opioid patch was initiated in 596 of 5297 residents (11.3%: 2.6% fentanyl, 8.7% buprenorphine) in the 60 residential aged care facilities. The mean age at initiation was 87 years, and 74% of the recipients were women. The proportion of recipients who were opioid‐naive before patch initiation was 34% for fentanyl and 49% for buprenorphine. Most were initiated at the lowest available patch strength, and the dose was up‐titrated after initiation. Around 15% of fentanyl users and 10% of buprenorphine users needed additional regular opioids after patch initiation. Conclusions: The results suggest some inappropriate initiation of opioid patches in Australian residential aged care facilities. Contrary to best practice, a third of residents initiated on fentanyl patches were opioid‐naive in the 4 weeks before initiation.

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“…Moreover, some authors have reported that a factor involved in the hyperalgesia is the short duration of action of opioids, such as remifentanil [7][8][9][10] . The main mechanism of hyperalgesia induced by opioids is the activation of N-methyl-D-aspartate (NMDA) receptors [11][12][13][14] .…”

Section: Introductionmentioning

confidence: 99%

Avaliação do efeito da cetamina associada à remifentanila na dor pós-operatória

Leal¹,

Sakata²,

Salomão³

et al. 2013

Rev. Bras. Anestesiol.

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Background and objectives: The combination of ketamine and remifentanil seems to be associated with better analgesia and duration. The aim of this study was to evaluate whether a ketamineremifentanil combination promotes improved postoperative analgesia. Methods: Prospective, randomized, double blind study of 40 patients undergoing video laparoscopic cholecystectomy. Anesthesia was performed with remifentanil, propofol, atracurium, and 50% oxygen. Group 1 (GI) patients received remifentanil (0.4 mcg.kg ) and saline solution. Morphine 0.1 mg.kg -1 was administered at the end of the procedure, and postoperative pain was treated with morphine via PCA. We evaluated the severity of postoperative pain by a numerical scale from zero to 10 during 24 hours. We registered the time to the fi rst analgesic supplementation, amount of morphine used in the fi rst 24 hours, and adverse effects. Results: There was a decrease in pain severity between extubation and other times evaluated in G1 and G2. There was no signifi cant difference in pain intensity between the groups. There was no difference between G1 (22 ± 24.9 min) and G2 (21.5 ± 28.1 min) regarding time to fi rst dose of morphine and dose supplement of morphine consumed in G1 (29 ± 18.4 mg) and G2 (25.1 ± 13.3 mg). Conclusion: The combination of ketamine (5 mcg.kg

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Development of Acute Opioid Tolerance During Infusion of Remifentanil for Pediatric Scoliosis Surgery

Cited by 162 publications

References 25 publications

Pre-treatment with morphine does not prevent the development of remifentanil-induced hyperalgesia

Pre-treatment with morphine does not prevent the development of remifentanil-induced hyperalgesia

Safety of opioid patch initiation in Australian residential aged care

Avaliação do efeito da cetamina associada à remifentanila na dor pós-operatória

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