The influence of dexmedetomidine on remifentanil‑induced hyperalgesia and the sex differences

Qiu, H.; Sun, Zhe; Shadhiya, Fathima; Arulthas, Renuka; Priya, Gita Vishnu; Christopher, Pariyatha; Muhammad, Zulaihat; Yu, Yonghao

doi:10.3892/etm.2018.6641

Cited by 12 publications

(20 citation statements)

References 36 publications

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“…NRS scores at the first postoperative hour were lower in group D both at rest and at movement. This is probably a consequence of the alleviation of remifentanil induced hyperalgesia [25], another property of DEX, but this effect didn't make difference 2 hours after operation in this research. In a study during abdominal hysterectomy, intraoperative administration of DEX leaded to higher sedation scores immediately after extubation [26].…”

Section: Discussionmentioning

confidence: 54%

Postoperative Effects of Continuous Dexmedetomidine Infusion During Gynecological Laparoscopy: A Randomized, Placebo-Controlled, Double-Blind, Single Center Clinical Trial

Liu¹,

Wang²,

Gao³

et al. 2020

Preprint

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Background: Dexmedetomidine(DEX) has proven to be an effective adjuvant to anesthetics owing to its sympatholytic, analgesic, and sedative properties. This study was designed to investigate the postoperative effects of continuous DEX infusion during gynecological laparoscopy and to evaluate the safety of this treatment. Methods: Sixty patients undergoing selective gynecological laparoscopy with general anesthesia were randomly assigned into DEX group (group D )and normal saline group (group N). DEX was infused at 0.5ug/kg/h during anesthesia maintenance in group D while normal saline was infused at the same rate in group N. The primary outcome measures were heart rate and blood pressure at extubation, 1, 2, 3, 4, 5, 6, 7, 8, 12, 24 and 48 hours after operation, NRS scores at 1, 2, 3 ,4, ,8,12,24 hours after surgery and OAA/S scores after extubation. The secondary outcome measures were time to extubation, propofol and remifentanil dosage during anesthesia, postoperative adverse events, and postoperative hospital stay.Results: Systolic and diastolic blood pressures were lower in group D at extubation when compared with group N (P<0.05), but not different at the first postoperative hour or after. HR was lower both at extubation and the first postoperative hour in group D (P<0.05). NRS scores were lower in patients given DEX both at rest and movement at the first postoperative hour (P<0.05). Time to extubation and OAA/S scores after extubation were not different between groups. Postoperative respiratory depression, shivering and pruritus didn’t occur in this research. There were no significant differences in the incidence rate of postoperative adverse events or postoperative hospital stay between the groups.Conclusions: Continuous infusion of DEX during gynecological laparoscopy provided better hemodynamic stability at extubation and the effects on HR continued until 1 hour after operation. DEX administration was associated with lower NRS scores at the first postoperative hour without excessive sedation. DEX is a useful and safe adjuvant for general anesthesia during gynecological laparoscopy.

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Section: Discussionmentioning

confidence: 54%

Postoperative Effects of Continuous Dexmedetomidine Infusion During Gynecological Laparoscopy: A Randomized, Placebo-Controlled, Double-Blind, Single Center Clinical Trial

Liu¹,

Wang²,

Gao³

et al. 2020

Preprint

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“…Observations of other studies indicated that in order to reduce intra-operatively administered opioid doses, multimodal analgesia or adjuvant drugs may be helpful (7, 8). In order to achieve adequate analgesia, adjuvant drugs including N-methyl-D-aspartate (NMDA) receptor inhibitors such as ketamine, magnesium, dexmedetomidine, or gabapentin can be suggested, as their potentials for pain reduction and OIH/OT prevention is well documented (8-10). Similarly, opioid-free anesthesia appears to be the appropriate option in relation to fentanyl-related OIH/OT.…”

Section: Discussionmentioning

confidence: 99%

A High Dose of Fentanyl May Accelerate the Onset of Acute Postoperative Pain

Rupniewska-Ładyko

Malec-Milewska

2019

Anesth Pain Med

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Fentanyl is a popular intraoperative analgesic linked with the development of opioid tolerance (OT) or opioid-induced hyperalgesia (OIH). The development of OIH or OT may lead to several issues such as delayed healing after surgery and timely discharge. Moreover, it causes discomfort in patients with higher pain scores, greater use of analgesics, and other associated side effects. The current study aimed at determining whether the amount of intraoperatively administered fentanyl affects the onset of acute postoperative pain. The current retrospective study was conducted on 56 patients undergoing laparoscopic sleeve gastrectomy. In patients receiving relatively large doses of fentanyl intraoperatively (over 3 µg/kg body weight), the onset of acute postoperative pain accelerated significantly, in comparison with the ones receiving lower doses.

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“…Despite receiving a moderately high‐dose of dexmedetomidine (2.8 mcg/kg), he still developed OIH. Meanwhile, adult studies have shown dexmedetomidine to prevent OIH at infusion rates ranging from 0.2 to 0.7 mcg kg −1 h −1 and treat OIH at rates ranging from 0.2 to 0.8 mcg kg −1 h −1 21–27 . It is unclear if fentanyl administration by infusion, as we administered, alters the risk of OIH, but infusions often result in the administration of higher cumulative doses of opioids compared to bolus dosing, and the total dose administered certainly impacts the risk of OIH 8 .…”

Section: What Is New and Conclusionmentioning

confidence: 96%

“…Meanwhile, adult studies have shown dexmedetomidine to prevent OIH at infusion rates ranging from 0.2 to 0.7 mcg kg À1 h À1 and treat OIH at rates ranging from 0.2 to 0.8 mcg kg À1 h À1 . [21][22][23][24][25][26][27] It is unclear if fentanyl administration by infusion, as we administered, alters the risk of OIH, but infusions often result in the administration of higher cumulative doses of opioids compared to bolus dosing, and the total dose administered certainly impacts the risk of OIH. 8 Following our patient's subsequent surgery for colostomy takedown, he did not display signs or symptoms of OIH and opioids effectively produced analgesia.…”

Section: What Is New and Conclusionmentioning

confidence: 97%

Suspected opioid‐induced hyperalgesia in an infant following surgery: A case report

Efune

Rebstock

2022

Clinical Pharmacy Therapeu

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What is Known and Objective Opioids are commonly administered to infants having surgery. Opioid induced hyperalgesia (OIH) is a known adverse effect of opioids in adults but can be difficult to identify in infants. Case Summary A 3‐month‐old received high‐dose fentanyl during anorectoplasty for imperforate anus. He had signs and symptoms of OIH immediately after surgery. His pain and agitation were difficult to manage but improved after he received ketamine. What is New and Conclusion OIH should be considered in infants postoperatively when pain worsens despite administration of escalating doses of opioids. Ketamine can be an effective therapeutic for OIH.

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The influence of dexmedetomidine on remifentanil‑induced hyperalgesia and the sex differences

Cited by 12 publications

References 36 publications

Postoperative Effects of Continuous Dexmedetomidine Infusion During Gynecological Laparoscopy: A Randomized, Placebo-Controlled, Double-Blind, Single Center Clinical Trial

Postoperative Effects of Continuous Dexmedetomidine Infusion During Gynecological Laparoscopy: A Randomized, Placebo-Controlled, Double-Blind, Single Center Clinical Trial

A High Dose of Fentanyl May Accelerate the Onset of Acute Postoperative Pain

Suspected opioid‐induced hyperalgesia in an infant following surgery: A case report

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