High-dose intraoperative remifentanil infusion increases early postoperative analgesic consumption: a prospective, randomized, double-blind controlled study

Kim, Deokkyu; Lim, Hyungsun; Kim, Myung-Jong; Jeong, Woojoo; Ko, Seonghoon

doi:10.1007/s00540-018-2569-6

Cited by 18 publications

(26 citation statements)

References 24 publications

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“…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%

“…Abdominal surgery 6 Guignard et al, 33 Joly et al, 34 Kim et al, 37 Kong et al, 38 Koo et al, 39 Lee (1) Fechner et al, 31 Florkiewicz et al, 32 Richebé et al, 45 Yildirim…”

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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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: 37mentioning

confidence: 99%

mentioning

confidence: 99%

“…Abdominal surgery 6 Guignard et al, 33 Joly et al, 34 Kim et al, 37 Kong et al, 38 Koo et al, 39 Lee (1) Fechner et al, 31 Florkiewicz et al, 32 Richebé et al, 45 Yildirim…”

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