Interaction between postoperative shivering and hyperalgesia caused by high-dose remifentanil

Abstract

BackgroundHigh-dose remifentanil-based anesthesia is associated with opioid-induced hyperalgesia (OIH) and postanesthetic shivering (PAS). These effects can be prevented by N-methyl-d-aspartate (NMDA) receptor antagonists. This study aimed to investigate correlations between OIH and PAS caused by high-dose remifentanil and the effects of low-dose ketamine on OIH and PAS.MethodsSeventy-five patients scheduled for single-port laparoscopic gynecologic surgery were randomly allocated into three groups, each of which received intraoperative remifentanil: group L at 0.1 µg/kg/min; group H at 0.3 µg/kg/min; and group HK at 0.3 µg/kg/min plus 0.25 mg/kg ketamine just before incision, followed by a continuous infusion of 5 µg/kg/min ketamine until skin closure.ResultsPAS, postoperative tactile pain threshold, and the extent of hyperalgesia in group H were significantly different (P < 0.05) than in the other two groups. PAS was significantly correlated with OIH, including mechanically evoked pain such as postoperative tactile pain threshold (r = -0.529, P = 0.01) (r = -0.458, P = 0.021) and the extent of hyperalgesia (r = 0.537, P = 0.002) (r = 0.384, P = 0.031), respectively, in group H and group HK. Notably, both groups were treated with high-dose remifentanil. Tympanic membrane temperature, time to first postoperative analgesic requirement, postoperative pain scores, analgesic consumption, and cumulative patient-controlled analgesia volume containing morphine were comparable in all three groups.ConclusionsOIH, including the enhanced perception of pain, and PAS were both associated with high-dose remifentanil, were significantly correlated and were attenuated by a low dose of ketamine. This suggests that a common mechanism in part mediated through activation of the central glutamatergic system (e.g., NMDA receptors), underlies the two effects caused by high doses of remifentanil.

Intraoperative naloxone reduces remifentanil-induced postoperative hyperalgesia but not pain: a randomized controlled trial

“…5 29 In our study, the intraoperative use of the high-dose remifentanil compared with the low dose decreased the pain thresholds and increased the incidence of hyperalgesia on the peri-incisional area, in agreement with previous studies. 30 31 Our study showed that adding the low-dose naloxone (0.05 lg kg À1 h À1 ) to the high-dose remifentanil during anaesthesia significantly reduced postoperative hyperalgesia on the periincisional area compared with using remifentanil alone. This anti-hyperalgesic effect of naloxone is likely to be produced by antagonizing or modifying NMDA 4 8 26 32 and l-opioid receptor activities 5 17 33 34 related to the opioid-induced hyperalgesia, although our study did not investigate its precise mechanisms.…”

Efficacy of forced‐air warming for preventing perioperative hypothermia and related complications in patients undergoing laparoscopic surgery: A randomized controlled trial

“…Shivering can occur when core temperature decreases by 1°C. Additionally, most anaesthetics lower the threshold for shivering, thereby increasing shivering (Song et al, ). Our study suggests that visual scales should be used to evaluate the degree of shivering as standard clinical practice to prevent consequent complications.…”

Remifentanil tolerance and hyperalgesia: short‐term gain, long‐term pain?

“…Of the seven which employed quantitative sensory testing methods, six used von Frey filaments to measure either mechanical pain threshold (three studies) or the area of hyperalgesia (three studies). Of note, where two of these six studies found significant differences using von Frey filaments, the same studies did not find any significance when using a pressure algometer for pressure pain or tactile pain thresholds . The one study which did not use von Frey filaments chose to measure deep pressure pain tolerance and cold pain from an ice bath.…”