de Hoogd Sjoerd, Ahlers Sabine J G M, van Dongen Eric P A, van de Garde Ewoudt M W, Hamilton-Ter Brake Tanja A T, Dahan Albert, Tibboel Dick, Knibbe Catherijne A J
Departments of *Clinical Pharmacy †Anesthesiology and Intensive Care, St Antonius Hospital, Nieuwegein ‡Department of Anesthesiology, Leiden University Medical Center ∥Division of Pharmacology, Leiden Academic Centre for Drug Research, Leiden University, Leiden §Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
Clin J Pain. 2016 Aug;32(8):726-35. doi: 10.1097/AJP.0000000000000317.
Remifentanil is an ultra-short-acting opioid that is used commonly during both short-term and prolonged surgery. This review investigated associations of intraoperative remifentanil administration with acute postoperative pain, hyperalgesia, and chronic postoperative pain, with emphasis on the perioperative coanesthetic drug regimen used.
Medline and Embase databases were searched for randomized studies, evaluating the intraoperative use of remifentanil (>2 h) versus another analgesic or a different dosage of remifentanil, and reporting acute postoperative pain parameters such as postoperative pain scores, hyperalgesia, acute opioid tolerance, or analgesics requirements. Furthermore, all studies in which remifentanil was used intraoperatively and parameters for chronic postoperative pain were measured were included (pain levels after a prolonged period of time after surgery).
From the 21 studies that were identified, less than half of the studies found higher acute postoperative pain, higher postoperative analgesic requirements after intraoperative remifentanil use, or both. Coanesthetics to some extent determined this incidence, with mainly studies using volatile agents reporting increased pain levels. There was less evidence when remifentanil was combined with total intravenous anesthesia or a combination of anesthetics. The limited number of studies (n=4) evaluating chronic pain suggested a potential association with the intraoperative use of remifentanil.
Although studies are diverse and sample sizes small, coanesthetics used in combination with remifentanil may influence the occurrence of postoperative hyperalgesia. No firm conclusions could be made regarding acute and chronic pain, indicating that further research with the goal to investigate the effect of volatile or intravenous anesthetics along with simultaneous remifentanil infusion on acute and chronic postoperative pain is needed.
瑞芬太尼是一种超短效阿片类药物，常用于短期和长时间手术。本综述调查了术中使用瑞芬太尼与术后急性疼痛、痛觉过敏和慢性术后疼痛之间的关联，重点关注围手术期联合使用的麻醉辅助药物方案。
检索Medline和Embase数据库，查找评估术中使用瑞芬太尼（>2小时）与另一种镇痛药或不同剂量瑞芬太尼对比，并报告术后急性疼痛参数（如术后疼痛评分、痛觉过敏、急性阿片类药物耐受性或镇痛药需求）的随机研究。此外，纳入所有术中使用瑞芬太尼并测量慢性术后疼痛参数的研究（术后较长时间后的疼痛程度）。
在确定的21项研究中，不到一半的研究发现术中使用瑞芬太尼后术后急性疼痛更高、术后镇痛药需求更高，或两者皆有。麻醉辅助药物在一定程度上决定了这种发生率，主要是使用挥发性麻醉剂的研究报告疼痛水平增加。当瑞芬太尼与全静脉麻醉或麻醉剂组合联合使用时，证据较少。评估慢性疼痛的研究数量有限（n = 4），提示与术中使用瑞芬太尼可能存在关联。
尽管研究多样且样本量小，但与瑞芬太尼联合使用的麻醉辅助药物可能会影响术后痛觉过敏的发生。关于急性和慢性疼痛无法得出确凿结论，这表明需要进一步研究，目标是调查挥发性或静脉麻醉剂与同时输注瑞芬太尼对术后急性和慢性疼痛的影响。
