Effect of remifentanil on postoperative pain in gynecologic surgery with sevoflurane anesthesia

Cho, Ah Reum; Kim, Hae Kyu; Kim, Kyung Hoon; Jung, Kyu Yeon; Kim, Won Sung; Kwon, Jae Young

doi:10.4097/kjae.2008.55.2.182

Cited by 7 publications

(18 citation statements)

References 34 publications

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“…40 Attempts were made to contact nine authors and none provided the requested data. [26][27][28]30,35,39,40,47,48 Reasons behind biases assessment are given in Table S2. 31,44 and one alfentanil.…”

Section: Re Sultsmentioning

confidence: 99%

“…35 All trials administered opioids before surgical incision. The administered dose ratio between lowand high-dose groups were respectively 1:15 in one trial, 27 between 1:8 and 1:6 in five trials, 29,34,37,41,52 between 1:5 and 1:2 in 18 trials 26,28,[31][32][33]35,36,[38][39][40]42,43,[46][47][48][49][50][51] and at a ratio of 1:1.5 in three trials. 30,44,45 Of note, one trial administered dose that are beyond what is commonly used in the clinical practice.…”

Section: Re Sultsmentioning

confidence: 99%

“…35 No trials injected long-acting opioids such as morphine or hydromorphone at the end of surgery. Over 60% (18 of 27) of the included trials used a volatile-based anaesthesia maintenance, [26][27][28][29][33][34][35][37][38][39][40][41][42]44,46,48,50 while the remaining trials administered propofol. [30][31][32]36,43,45,47,49,51,52 Regarding the types of surgery, authors included patients scheduled for gynaecological surgery in seven trials, [27][28][29][30]35,42,44 for abdominal surgery in nine trials, 33,34,[37][38][39]41,43,49,50 for cardiac surgery in four trials, 31,32,45,51 and finally, we combined the remaining seven tr...…”

Section: Re Sultsmentioning

confidence: 99%

“…According to anaesthesia maintenance Volatile anaesthetic 16 Agata et al, 26 Cho et al, 28 Choi et al, 29 Guignard et al, 33 Katz et al, 35 Kim et al, 37 Kong et al, 38 Koo et al, 39 Koo et al, 40 Lee (1) et al, 41 Lee (2) et al, 42 Lee et al, 44 Schmidt et al, 46 Shin et al, 47 Song et al, 48 Treskatsch Fechner et al, 31 Florkiewicz et al, 32 Kim et al, 36 Shin et al, 47 Yildirim et al, 51 Zhang Cho et al, 28 Choi et al, 29 Katz et al, 35 Lee (2)…”

Section: 37mentioning

confidence: 99%

“…Agata et al, 26 Cho et al, 28 Choi et al, 29 Florkiewicz et al, 32 Guignard et al, 33 Kim et al, 36 Kim et al, 37 Kong et al, 38 Koo et al, 39 Koo et al, 40 Lee (1) et al, 41 Lee (2) et al, 42 Schmidt et al, 46 Shin et al, 47 Song et al, 48 Treskatsch et al, 50 Zhang…”

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confidence: 99%

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Low‐ versus high‐dose intraoperative opioids: A systematic review with meta‐analyses and trial sequential analyses

Albrecht

Grape

Frauenknecht

et al. 2019

Acta Anaesthesiol Scand

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Background Opioid‐induced hyperalgesia is a state of nociceptive sensitisation secondary to opioid administration. The objective of this meta‐analysis was to test the hypothesis that high‐dose intraoperative opioids contribute to increased post‐operative pain and hyperalgesia when compared with a low‐dose regimen in patients under general anaesthesia. Methods We followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses statement guidelines and rated the certainty of evidence with the Grading of Recommendations, Assessment, Development and Evaluation system. Only trials investigating pain outcomes and comparing two different dosages of the same intraoperative opioid in patients under general anaesthesia were included. The primary outcome was pain score (analogue scale, 0‐10) at 24 post‐operative hours. Secondary outcomes included pain score and cumulative intravenous morphine equivalents (mg) consumed at 2 post‐operative hours, together with mechanical pain threshold (g·mm−2). Results Twenty‐seven randomised controlled trials, including 1630 patients, were identified. Pain score at rest at 24 post‐operative hours was increased in the high‐dose group (mean difference [95% CI]: −0.2 [−0.4, −0.1]; trial sequential analysis‐adjusted CI: −0.4, −0.02; low certainty of evidence). Similarly, at 2 post‐operative hours, both pain score (mean difference [95% CI]: −0.4 [−0.6, −0.2]; low certainty of evidence) and cumulative intravenous morphine equivalents consumed (mean difference [95% CI]: −1.6 mg [−2.6, −0.7]; low certainty of evidence) were significantly higher in the high‐dose group. Finally, the threshold for mechanical pain was significantly lower in the high‐dose group (mean difference to pressure [95% CI]: 3.8 g·mm−2 [1.8, 5.8]; low certainty of evidence). Conclusions There is low certainty of evidence that high‐dose intraoperative opioid administration increases pain scores in the post‐operative period, when compared with a low‐dose regimen.

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Section: Re Sultsmentioning

confidence: 99%

Section: Re Sultsmentioning

confidence: 99%

Section: Re Sultsmentioning

confidence: 99%

Section: 37mentioning

confidence: 99%

mentioning

confidence: 99%

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Low‐ versus high‐dose intraoperative opioids: A systematic review with meta‐analyses and trial sequential analyses

Albrecht

Grape

Frauenknecht

et al. 2019

Acta Anaesthesiol Scand

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Opioid-induced hyperalgesia in patients after surgery: a systematic review and a meta-analysis

Fletcher

Martinez

2014

British Journal of Anaesthesia

497

321

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Analgesic impact of intra‐operative opioids vs. opioid‐free anaesthesia: a systematic review and meta‐analysis

et al. 2019

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Efficacité analgésique d'une anesthésie avec opioïdes versus sans opioïdes : une revue systématique de la littérature avec méta-analyses [Analgesic impact of intra-operative opioids versus opioid free anesthesia: a systematic review and meta-analysis] Les opioïdes sont administrés durant l'intervention afin de contrôler la réponse sympathique à un stimulus chirurgical, mais aussi pour soulager la douleur postopératoire. Récemment, l'utilisation des opioïdes durant la chirurgie a été remise en question en raison de l'absence probable de bénéfice dans la phase postopératoire immédiat, mais aussi en raison des effets secondaires, tels que les nausées et vomissements postopératoires. Le but de cette méta-analyse est d'investiguer si l'utilisation d'opioïde intraopératoire comparée à une stratégie sans opioïde permet de diminuer les douleurs postopératoires sans augmenter le taux de nausées et vomissements postopératoires. Nous avons inclus des essais cliniques randomisés et contrôlés effectués chez des patients adultes pour tout type de chirurgie qui ont étudié l'efficacité analgésique postopératoire d'une administration intraopératoire d'opioïde avec soit l'administration d'un placebo, soit l'absence d'administration. L'analyse des 23 études identifiées avec plus de 1300 patients inclus a démontré que les scores de douleurs au repos (échelle de 0 à 10, 0 étant aucune douleur et 10 la pire douleur imaginable) à 2h postopératoire étaient équivalents dans les deux groupes, avec une différence moyenne (IC 95%) de 0,2 point (-0,2 à 0,5), p=0,38. Les taux de nausées et vomissements postopératoires étaient de 24% dans le groupe avec opioïde et 19% dans le groupe sans ce qui représente un risque relatif (IC 95%) de 0,77 (0,61 à 0,97), p=0,03. En conclusion, l'utilisation d'opioïde intraopératoire ne diminue pas les douleurs postopératoires, mais est associée à une augmentation des nausées et vomissements postopératoire.

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Effect of remifentanil on postoperative pain in gynecologic surgery with sevoflurane anesthesia

Cited by 7 publications

References 34 publications

Low‐ versus high‐dose intraoperative opioids: A systematic review with meta‐analyses and trial sequential analyses

Low‐ versus high‐dose intraoperative opioids: A systematic review with meta‐analyses and trial sequential analyses

Opioid-induced hyperalgesia in patients after surgery: a systematic review and a meta-analysis

Analgesic impact of intra‐operative opioids vs. opioid‐free anaesthesia: a systematic review and meta‐analysis

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