Intraoperative Use of Remifentanil for TIVA: Postoperative Pain, Acute Tolerance, and Opioid-Induced Hyperalgesia

Randomized Controlled Trial on the Influence of Intraoperative Remifentanil versus Fentanyl on Acute and Chronic Pain after Cardiac Surgery

“…Opioids are part of the multimodal anesthesia regimen for the management of pain during and after surgery. One of these opioids, remifentanil, is often used because of its favorable pharmacokinetic and pharmacodynamic properties, including fast onset and offset of action, predictable rapid recovery profile independent of infusion duration, and metabolism independent of kidney or liver function …”

Pharmacological sedation management in the paediatric intensive care unit

“…In a paediatric study, remifentanil was as effective as fentanyl for sedation and analgesia and allowed for earlier extubation . However, its use carries the risk of opioid‐induced hyperalgesia (OIH) that is a phenomenon seen after opioid administration, notably on account of its short half‐life and fast onset of action . It has been suggested that ketamine or clonidine as adjuvants could prevent the OIH, but these agents may have unwanted side effects.…”

Managing Opioid-Tolerant Patients in the Perioperative Surgical Home

“… A phenomenon whereby increasing opioid doses are required for analgesia due to a desensitization of pain signaling at the opioid receptor (9).  These higher opioid doses are associated with an increased risk of adverse events (9).…”