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

Hoogd, Sjoerd de; Ahlers, Sabine; Dongen, Eric P.A. van; Garde, E.M.W. van de; Daeter, Edgar J.; Dahan, Albert; Tibboel, Dick; Knibbe, Catherijne A. J.

doi:10.1111/papr.12615

Cited by 41 publications

(30 citation statements)

References 37 publications

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“…A large study using the PAIN OUT database (see http://pain-out.med.unijena.de/) found an association between worse pain-related outcomes and intraoperative use of remifentanil (63). More recent studies have strengthened this finding, with younger patients seeming to be at higher risk (64). The cause of the apparent higher risk of OIH with remifentanil compared to other opioids is unclear, but may be related to the fast onset/ offset of its action.…”

Section: Clinical Evidence For Oihmentioning

confidence: 99%

Perioperative opioid analgesia—when is enough too much? A review of opioid-induced tolerance and hyperalgesia

2019

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Section: Clinical Evidence For Oihmentioning

confidence: 99%

Perioperative opioid analgesia—when is enough too much? A review of opioid-induced tolerance and hyperalgesia

2019

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“…Interestingly, this effect was more pronounced in younger patients and in those receiving a higher dose of remifentanil. 18 Another observational study showed worse patient-reported outcomes (higher “worst pain” and lower satisfaction with pain control) after thyroidectomy when they received remifentanil as compared with patients receiving fentanyl as intraoperative opioid. 19 Such and other studies highlight the importance of adopting strategies to decrease the risk of remifentanil-induced hyperalgesia (RIH), from the avoidance of high doses of remifentanil to the implementation of drugs specifically targeting the mechanisms of OIH/RIH.…”

Section: Introductionmentioning

confidence: 99%

Remifentanil-induced postoperative hyperalgesia: current perspectives on mechanisms and therapeutic strategies

Santonocito¹,

Noto²,

Crimi³

et al. 2018

LRA

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The use of remifentanil in clinical practice offers several advantages and it is used for a wide range of procedures, ranging from day-surgery anesthesia to more complex procedures. Nonetheless, remifentanil has been consistently linked with development of opioid-induced hyperalgesia (OIH), which is described as a paradoxical increase in sensitivity to painful stimuli that develops after exposure to opioid treatment. The development of OIH may cause several issues, delaying recovery after surgery and preventing timely patient’s discharge. Moreover, it causes patient’s discomfort with higher pain scores, greater use of analgesics, and associated side effects. Remifentanil is the opioid most convincingly associated with OIH, and hereby we provide a review of remifentanil-induced hyperalgesia, describing both the underlying mechanisms involved and the available studies investigating experimental and clinical pharmacologic approaches aiming at reducing its incidence and degree.

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“…Besides standard postoperative analgesics, the use of corticosteroids, N-methyl-D-aspartate (NMDA) antagonists, alpha-2 agonists, local anesthetics and gabapentinoids are all suggested to reduce the risk for CPSP after cardiac surgery [5]. However, no specific therapy is verified to protect against CPSP [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Rationale and design of influence of volatile anesthesia versus total intravenous anesthesia on chronic postsurgical pain after cardiac surgery using Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials criteria assessment: study protocol for a prospective randomized controlled trial

Zheng

Hua

et al. 2019

Preprint

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Background Many patients develop chronic postsurgical pain (CPSP) after cardiac surgery, which interferes with sleep, mood and quality of life. Studies have suggested that propofol improved postoperative analgesia compared with volatile anesthetics, but the prevention effect on CPSP following cardiac surgery is still unknown. This study has been designed to compare the incidence in CPSP following cardiac surgery receiving volatile anesthesia compared to propofol-based total intravenous anesthesia (TIVA) using Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) criteria assessment. Methods This is a prospective randomized controlled trial. Five hundred adult patients undergoing cardiac surgery will be randomly allocated to the volatile or the TIVA group. The volatile group will receive sevoflurane or desflurane during surgery to provide general anesthesia. The TIVA group will receive propofol-based intravenous agents and no volatile agents during surgery. The primary outcome will be the frequency of CPSP at 3 months, 6 months and 1 year after surgery. CPSP is defined as two ways: sternal and/or thoracic pain: (1) numeric rating scale, NRS >0; (2) meets all six IMMPACT criteria for CPSP assessed using validated pain instruments. Discussion To our knowledge, this is the first prospective randomized protocol investigating the prevention of CPSP following cardiac surgery receiving volatile anesthesia compared to propofol-based TIVA using validated pain instruments in accordance with the IMMPACT recommendations. This study will provide important information on whether the choice of these two anesthetic regimens might influence CPSP after cardiac surgery. Trial registration: Chictr.org.cn, ID ChiCTR1900020747. Registered on 16 January 2019.

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

Cited by 41 publications

References 37 publications

Perioperative opioid analgesia—when is enough too much? A review of opioid-induced tolerance and hyperalgesia

Perioperative opioid analgesia—when is enough too much? A review of opioid-induced tolerance and hyperalgesia

Remifentanil-induced postoperative hyperalgesia: current perspectives on mechanisms and therapeutic strategies

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