Zöllner C, Schäfer M
Klinik für Anaesthesiologie und operative Intensivmedizin, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin.
Anaesthesist. 2007 Oct;56(10):1038-46. doi: 10.1007/s00101-007-1246-1.
Remifentanil is a synthetic opioid derivate with an agonist activity at mu-opioid receptors. The pharmacokinetic profile differs from other synthetic opioids. Remifentanil is rapidly metabolised by unspecific blood and tissue esterases and the metabolites have almost no intrinsic activity. According to its unique pharmacokinetic profile, remifentanil-based anaesthesia might be associated with a high level of postoperative pain, therefore, an appropriate postoperative pain management is an import aspect. In addition, remifentanil withdrawal induces a compensatory up-regulation of secondary messenger pathways, inducing hyperalgesia. This review provides a comprehensive summary of basic and clinical research concerning the intraoperative use of remifentanil and postoperative pain therapy. The relative contribution of rapid degradation and withdrawal-induced hyperalgesia to postoperative pain will be discussed. In addition, this review attempts to identify potential clinical implications and treatment strategies.
瑞芬太尼是一种合成阿片类衍生物，对μ-阿片受体具有激动活性。其药代动力学特征与其他合成阿片类药物不同。瑞芬太尼可被非特异性血液和组织酯酶快速代谢，且代谢产物几乎没有内在活性。根据其独特的药代动力学特征，基于瑞芬太尼的麻醉可能与术后疼痛程度较高有关，因此，适当的术后疼痛管理是一个重要方面。此外，瑞芬太尼戒断会导致二级信使通路的代偿性上调，从而引发痛觉过敏。本综述全面总结了关于瑞芬太尼术中使用及术后疼痛治疗的基础和临床研究。将讨论快速降解和戒断诱导的痛觉过敏对术后疼痛的相对影响。此外，本综述试图确定潜在的临床意义和治疗策略。
