Excessive remifentanil during total intravenous anesthesia is associated with increased risk of pain after robotic thyroid surgery

Abstract

The widespread use of remifentanil during total intravenous anesthesia (TIVA) has raised concerns about the risk of postoperative remifentanil-associated pain. Although a recent meta-analysis suggests that remifentanil-associated pain is unlikely to occur in patients with TIVA because of the protective effect of co-administered propofol, the evidence is not conclusive. We retrospectively assessed 635 patients who received robotic thyroid surgery under TIVA to evaluate the risk of remifentanil-associated pain. Postoperative pain was evaluated using 11-point numeric rating scale (NRS). Time dependent Cox proportional hazards regression analysis was used to determine the risk factors of treatment-requiring pain (NRS > 4) during the first 48 postoperative hours. Postoperative pain rapidly decreased, and treatment-requiring pain remained in 12.8% (81 out of 635) of patients at 48 hours postoperatively. After adjusting for the time-dependent analgesic consumption, intraoperative use of remifentanil > 0.2 mcg/kg/min was a positive predictor of postoperative pain with a hazard ratio of 1.296 (95% C.I., 1.014–1.656, P = 0.039) during 48 hours after surgery. In conclusion, excessive use of remifentanil during TIVA was associated with increased risk of pain after robotic thyroid surgery. Prospective trials are required to confirm these results and determine whether decreasing remifentanil consumption below the threshold can reduce postoperative pain.

Association between intraoperative remifentanil use and postoperative hyperalgesia in adolescent idiopathic scoliosis surgery: a retrospective study

“…This was supported by another randomized study [ 16 ] whereby intraoperative remifentanil of 0.40 µg/kg/min triggered significant hyperalgesia as well as a higher amount of morphine consumption for 48 h postoperatively when compared to the group that received lower remifentanil dose of 0.05 µg/kg/min. A more recent retrospective study identified that infusion of remifentanil of > 0.2 µg/kg/min increases the probability of treatment-requiring pain for 48 h after robotic thyroid surgery when adjusting for analgesic consumption and its interaction with time [ 17 ].…”