Department of Anesthesiology and Pain Medicine, Myongji Hospital, Kwandong University Medical School, Goyang, Korea.
Korean J Anesthesiol. 2011 Mar;60(3):198-204. doi: 10.4097/kjae.2011.60.3.198. Epub 2011 Mar 30.
Experimental and clinical studies have suggested that remifentanil probably causes acute tolerance or postinfusion hyperalgesia. This study was designed to confirm whether remifentanil given during propofol anesthesia induced postoperative pain sensitization, and we wanted to investigate whether pregabalin could prevent this pronociceptive effect.
Sixty patients who were scheduled for total abdominal hysterectomy were randomly allocated to receive (1) a placebo as premedication and an intraoperative saline infusion (control group), (2) a placebo as premedication and an intraoperative infusion of remifentanil at a rate of 3-4 ng/ml (remifentanil group), or (3) pregabalin 150 mg as premedication and an intraoperative infusion of remifentanil at a rate of 3-4 ng/ml (pregabalin-remifentanil group). Postoperative pain was controlled by titration of fentanyl in the postanesthetic care unit (PACU), followed by patient-controlled analgesia (PCA) with fentanyl. The patients were evaluated using the visual analogue scale (VAS) for pain scores at rest and after cough, consumption of fentanyl, sedation score and any side effects that were noted over the 48 h postoperative period.
The fentanyl titration dose given in the PACU was significantly larger in the remifentanil group as compared with those of the other two groups. At rest, the VAS pain score in the remifentanil group at 2 h after arrival in the PACU was significantly higher than those in the other two groups.
The results of this study show that remifentanil added to propofol anesthesia causes pain sensitization in the immediate postoperative period. Pretreatment with pregabalin prevents this pronociceptive effect and so this may be useful for the management of acute postoperative pain when remifentanil and propofol are used as anesthetics.
实验和临床研究表明，瑞芬太尼可能导致急性耐受或输注后痛觉过敏。本研究旨在证实丙泊酚麻醉期间给予瑞芬太尼是否会引起术后疼痛敏化，并探讨普瑞巴林是否可以预防这种伤害感受效应。
60 名拟行全子宫切除术的患者随机分为三组：（1）术前给予安慰剂和术中生理盐水输注（对照组）；（2）术前给予安慰剂和术中输注瑞芬太尼（3-4ng/ml）（瑞芬太尼组）；（3）术前给予普瑞巴林 150mg 和术中输注瑞芬太尼（3-4ng/ml）（普瑞巴林-瑞芬太尼组）。术后在麻醉后恢复室（PACU）通过芬太尼滴定控制疼痛，并采用芬太尼患者自控镇痛（PCA）。采用视觉模拟评分（VAS）评估患者静息和咳嗽时的疼痛评分、芬太尼消耗量、镇静评分以及术后 48 小时内出现的任何不良反应。
PACU 中瑞芬太尼组芬太尼滴定剂量明显大于其他两组。静息时，PACU 中瑞芬太尼组患者到达后 2 小时的 VAS 疼痛评分明显高于其他两组。
本研究结果表明，瑞芬太尼联合丙泊酚麻醉会导致术后即刻疼痛敏化。普瑞巴林预处理可预防这种伤害感受效应，因此当瑞芬太尼和丙泊酚作为麻醉剂时，普瑞巴林可能有助于急性术后疼痛的管理。
