Gradual withdrawal of remifentanil infusion may prevent opioid-induced hyperalgesia

Comelon, Marlin; Ræder, Johan; Stubhaug, Audun; Nielsen, CS; Drægni, Tomas; Lenz, Harald

doi:10.1093/bja/aev547

Cited by 50 publications

(42 citation statements)

References 33 publications

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“…36 However, the occurrence of opioid tolerance and hyperalgesia is typically observed after high-dose remifentanil infusion rates greater than 0.25 and 0.2 μg/kg per minute, respectively, and it may be relevant for the first few postoperative hours in a clinical setting. 37 In this regard, the impact of remifentanil might be minimal in our study because the infusion doses of remifentanil (0.01-0.05 μg/kg per minute) were substantially less than the reported doses to induce opioid tolerance and hyperalgesia. Nevertheless, we could not draw clear conclusion because we did not measure the development of opioid tolerance and hyperalgesia.…”

Section: Discussionmentioning

confidence: 68%

Effective Dose of Intravenous Dexmedetomidine to Prolong the Analgesic Duration of Interscalene Brachial Plexus Block

Kang

Jeong

Yoo

et al. 2018

Regional Anesthesia and Pain Medicine

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Section: Discussionmentioning

confidence: 68%

Effective Dose of Intravenous Dexmedetomidine to Prolong the Analgesic Duration of Interscalene Brachial Plexus Block

Kang

Jeong

Yoo

et al. 2018

Regional Anesthesia and Pain Medicine

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“…Regardless of the mechanisms involved, the study by Nguyen et al ( 2016 ) showing improved pain and functional outcomes after even a 50% reduction in preoperative opioid burden argues convincingly in the context of the other literature reviewed herein for a concerted effort toward preoperative opioid reduction if not elimination. Additional supporting evidence for this tactic comes from the recent demonstration that downtitration of remifentanil infusion rates is associated with a lower incidence of OIH (Comelon et al 2016 ).…”

Section: Discussionmentioning

confidence: 97%

Rationale for and approach to preoperative opioid weaning: a preoperative optimization protocol

McAnally

2017

Perioper Med

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The practice of chronic opioid prescription for chronic non-cancer pain has come under considerable scrutiny within the past several years as mounting evidence reveals a generally unfavorable risk to benefit ratio and the nation reels from the grim mortality statistics associated with the opioid epidemic. Patients struggling with chronic pain tend to use opioids and also seek out operative intervention for their complaints, which combination may be leading to increased postoperative “acute-on-chronic” pain and fueling worsened chronic pain and opioid dependence.Besides worsened postoperative pain, a growing body of literature, reviewed herein, indicates that preoperative opioid use is associated with significantly worsened surgical outcomes, and severely increased financial drain on an already severely overburdened healthcare budget. Conversely, there is evidence that preoperative opioid reduction may result in substantial improvements in outcome. In the era of accountable care, efforts such as the Enhanced Recovery After Surgery (ERAS) protocol have been introduced in an attempt to standardize and facilitate evidence-based perioperative interventions to optimize surgical outcomes. We propose that addressing preoperative opioid reduction as part of a targeted optimization approach for chronic pain patients seeking surgery is not only logical but mandatory given the stakes involved. Simple opioid reduction/abstinence however is not likely to occur in the absence of provision of viable and palatable alternatives to managing pain, which will require a strong focus upon reducing pain catastrophization and bolstering self-efficacy and resilience.In response to a call from our surgical community toward that end, we have developed a simple and easy-to-implement outpatient preoperative optimization program focusing on gentle opioid weaning/elimination as well as a few other high-yield areas of intervention, requiring a minimum of resources.

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“…It has been suggested that ketamine or clonidine as adjuvants could prevent the OIH, but these agents may have unwanted side effects. Gradual remifentanil withdrawal has been suggested as well, but OIH was still observed after cold pressure testing in one study . Moreover, chronic pain may develop after (prolonged) surgery, so more data on these issues are warranted before it is regularly used in children.…”

Section: Future Perspectivesmentioning

confidence: 99%

Pharmacological sedation management in the paediatric intensive care unit

Baarslag

Allegaert

Knibbe

et al. 2017

Journal of Pharmacy and Pharmacology

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The population in question is very heterogeneous and this overview can aid clinicians and researchers in moving from practice-based sedation management towards more evidence- or model-based practice. Still, paediatric sedation management can be improved in other ways than pharmacology only, so future research should aim on sedation assessment and implementation strategies of protocolized sedation as well.

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Gradual withdrawal of remifentanil infusion may prevent opioid-induced hyperalgesia

Abstract: NCT 01702389. EudraCT number 2011-002734-39.

Cited by 50 publications

References 33 publications

Effective Dose of Intravenous Dexmedetomidine to Prolong the Analgesic Duration of Interscalene Brachial Plexus Block

Effective Dose of Intravenous Dexmedetomidine to Prolong the Analgesic Duration of Interscalene Brachial Plexus Block

Rationale for and approach to preoperative opioid weaning: a preoperative optimization protocol

Pharmacological sedation management in the paediatric intensive care unit

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