Regulatory Effects of Propofol on High-Dose Remifentanil-Induced Hyperalgesia

Su, Xiaojun; Zhu, Wei; Tian, Yuan; Tan, Li; Wu, Haiyan; Wu, Lingling

doi:10.33549/physiolres.934133

Cited by 13 publications

(9 citation statements)

References 20 publications

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“…This is supported by several studies demonstrating attenuation of OIH/AOT when remifentanil is used in the context of propofol as opposed to volatile agents. [33][34][35] The antagonism of NMDA by propofol may also render further NMDA antagonism by ketamine superfluous, explaining the absence of significant effect ketamine use or dosage on MEQ72 in our multivariable regression analysis. Several other groups, including a study from our centre examining AIS patients, have similarly shown no effect of ketamine on ameliorating OIH/AOT in the context of a propofol anesthetic.…”

Section: Anesthesia and Analgesiamentioning

confidence: 93%

Association Between Intraoperative Remifentanil Dosage and Postoperative Opioid Consumption in Adolescent Idiopathic Spine Surgery: A Retrospective Cohort Study

Schwindt

Sharma

et al. 2021

Anesthesia &Amp; Analgesia

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BACKGROUND: Adolescent idiopathic scoliosis (AIS) surgery is associated with significant postoperative pain. Remifentanil is a short-acting opioid that is often used as a component of total intravenous anesthesia. Remifentanil has been implicated in acute opioid tolerance and opioid-induced hyperalgesia, resulting in increased postoperative pain and opioid consumption. This retrospective study sought to investigate the relationship between the dose of intraoperative remifentanil and cumulative postoperative opioid consumption through 72 hours following surgery for pediatric AIS patients. METHODS: We performed a retrospective chart review of adolescent patients undergoing posterior spine instrumentation under total intravenous general anesthesia at a single major pediatric center between January 2015 and October 2017. The relationship between intraoperative cumulative weight-adjusted remifentanil dose and logarithmic transformation of cumulative weight-adjusted opioid consumption through 72 hours following surgery was examined by regression analysis. A priori determined potential confounding variables were collected, including demographic data, perioperative analgesic agents (ie, ketamine, dexmedetomidine, and acetaminophen), surgical duration, vertebrae instrumented, and blood transfusion. Multivariable linear regression analysis was used to adjust for these possible confounding variables. RESULTS: Eighty-nine patients met inclusion criteria, of which 78 had complete data for analysis. Univariable linear regression analysis revealed no association between remifentanil dose and opioid consumption through 72 hours following surgery (slope = 0.79 [95% confidence interval [CI], 0.61-0.98; R 2 = 0.0039; P = .588]). After adjustment for possible confounding factors, no relationship between remifentanil dose (regression coefficient (coeff.) −0.08; 95% CI, −1.59 to 1.43; P = .912) and opioid consumption through 72 hours was found (slope =0.90 [95% CI, −0.65 to 2.46]; R 2 = 0.1634). Similar results were obtained when the model was repeated for opioid consumption in postanesthesia care unit (PACU). CONCLUSIONS: In this study examining adolescent patients undergoing surgery for idiopathic scoliosis, no association was found between the dose of intraoperative remifentanil and postoperative opioid consumption in the context of a propofol-based total intravenous anesthetic and multimodal analgesia. These results provide direction for future prospective controlled studies to further evaluate this relationship.

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Section: Anesthesia and Analgesiamentioning

confidence: 93%

Association Between Intraoperative Remifentanil Dosage and Postoperative Opioid Consumption in Adolescent Idiopathic Spine Surgery: A Retrospective Cohort Study

Schwindt

Sharma

et al. 2021

Anesthesia &Amp; Analgesia

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“…As the most e ective type of minimally invasive surgery for the treatment of gallbladder disease, it excels owing to its small incision, less bleeding, fast recovery time, and high clinical e cacy [1]. Clinical studies have pointed out that in the treatment of laparoscopic cholecystectomy, treatment e ects using di erent anesthesia methods are varying [2,3]. Previously, clinical anesthesia for patients undergoing laparoscopic cholecystectomy majorly used fentanyl plus propofol, but the anesthesia e ect yet remains unsatisfactory [4].…”

Section: Introductionmentioning

confidence: 99%

Anesthesia Effect of Remifentanil Combined with Propofol in Laparoscopic Cholecystectomy and Its Impact on Postoperative Cognitive Recovery

Jiang¹,

Wang

Ni³

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Objective. To investigate the anesthesia effect of remifentanil combined with propofol for laparoscopic cholecystectomy and its impact on postoperative cognitive recovery. Methods. A total of 120 patients who underwent laparoscopic cholecystectomy in our hospital from February 2019 to June 2021 were recruited and assigned into either control group or experimental group at a ratio of 1 : 1 via the random number table method. The patients in the control group were anesthetized with fentanyl combined with propofol, and the patients in the experimental group were anesthetized with remifentanil combined with propofol. The clinical basic indicators (extubation time, recovery time, breathing recovery time, and orientation recovery time), and observer’s assessment of awareness/sedation (OAA/S) scores and complications were compared between the two groups. Results. There was no significant difference in extubation time between the two groups ( P > 0.05 ). The postoperative wake-up time, respiratory recovery time, and orientation recovery time of the experimental group were significantly better than those of the control group ( P < 0.05 ). The OAA/S scores of the patients in the experimental group were significantly higher than those in the control group immediately after surgery, 1 h after surgery, and 3 h after surgery ( P < 0.05 ). There was no significant difference in the OAA/S scores between the two groups on the 1st day after operation ( P > 0.05 ). The incidence of complications in the experimental group was significantly lower than that in the control group ( P < 0.05 ). Conclusion. Remifentanil + propofol for laparoscopic cholecystectomy patients has a significant anesthesia effect. This strategy effectively shortens the extubation, awakening, respiratory recovery, orientation recovery time of patients, and OAA/S score, suggest a minor impact on the postoperative cognitive function and state of consciousness. It has a high safety profile and thus is worthy of clinical application.

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“…Therefore, in these conditions, clinicians need to be cautious about the possible occurrence of acute opioid tolerance 24,25,48 and OIH, which may impair pain treatment or even worsen pre-existing pain. According to the previously reported results, coadministration of anaesthetic drugs, such as propofol, 43,45 nitrous oxide, 49 magnesium, 42 ketamine, 5,39 and dexmedetomidine, 50 seem to be helpful to modulate the development of OIH, even if their modulatory effect needs to be further explored. However, there is a lack of validated approaches to diagnose OIH, which may limit the relevance of these results.…”

Section: Discussionmentioning

confidence: 99%

Remifentanil-induced hyperalgesia in healthy volunteers: a systematic review and meta-analysis of randomized controlled trials

Dello Russo,

Di Franco,

Tabolacci

et al. 2023

Pain

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Recent literature suggests that the withdrawal of remifentanil (RF) infusion can be associated with hyperalgesia in clinical and nonclinical settings. We performed a systematic review and a meta-analysis of randomized controlled trials with cross-over design, to assess the effect of discontinuing RF infusion on pain intensity and areas of hyperalgesia and allodynia in healthy volunteers. Nine studies were included. The intervention treatment consisted in RF infusion that was compared with placebo (saline solution). The primary outcome was pain intensity assessment at 30 ± 15 minutes after RF or placebo discontinuation, assessed by any pain scale and using any quantitative sensory testing. Moreover, postwithdrawal pain scores were compared with baseline scores in each treatment. Secondary outcomes included the areas (% of basal values) of hyperalgesia and allodynia. Subjects during RF treatment reported higher pain scores after discontinuation than during treatment with placebo [standardized mean difference (SMD): 0.50, 95% confidence interval (CI): 0.03-0.97; P = 0.04, I2 = 71%]. A significant decrease in pain scores, compared with baseline values, was found in the placebo treatment (SMD: −0.87, 95% CI: −1.61 to −0.13; P = 0.02, I2 = 87%), but not in the RF treatment (SMD: −0.28, 95% CI: −1.18 to 0.62; P = 0.54, I2 = 91%). The area of hyperalgesia was larger after RF withdrawal (SMD: 0.55; 95% CI: 0.27-0.84; P = 0.001; I2 = 0%). The area of allodynia did not vary between treatments. These findings suggest that the withdrawal of RF induces a mild but nonclinically relevant degree of hyperalgesia in HVs, likely linked to a reduced pain threshold.

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Regulatory Effects of Propofol on High-Dose Remifentanil-Induced Hyperalgesia

Cited by 13 publications

References 20 publications

Association Between Intraoperative Remifentanil Dosage and Postoperative Opioid Consumption in Adolescent Idiopathic Spine Surgery: A Retrospective Cohort Study

Association Between Intraoperative Remifentanil Dosage and Postoperative Opioid Consumption in Adolescent Idiopathic Spine Surgery: A Retrospective Cohort Study

Anesthesia Effect of Remifentanil Combined with Propofol in Laparoscopic Cholecystectomy and Its Impact on Postoperative Cognitive Recovery

Remifentanil-induced hyperalgesia in healthy volunteers: a systematic review and meta-analysis of randomized controlled trials

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