瑞芬太尼输注的逐渐停药可能预防阿片类药物诱发的痛觉过敏。
Gradual withdrawal of remifentanil infusion may prevent opioid-induced hyperalgesia.
机构信息
Division of Emergencies and Critical Care, Department of Anesthesiology Faculty of Medicine, University of Oslo, 0316 Oslo, Norway
Division of Emergencies and Critical Care, Department of Anesthesiology Faculty of Medicine, University of Oslo, 0316 Oslo, Norway.
出版信息
Br J Anaesth. 2016 Apr;116(4):524-30. doi: 10.1093/bja/aev547. Epub 2016 Mar 1.
BACKGROUND
The aim of this study was to examine if gradual withdrawal of remifentanil infusion prevented opioid-induced hyperalgesia (OIH) as opposed to abrupt withdrawal. OIH duration was also evaluated.
METHODS
Nineteen volunteers were enrolled in this randomized, double-blinded, placebo-controlled, crossover study. All went through three sessions: abrupt or gradual withdrawal of remifentanil infusion and placebo. Remifentanil was administered at 2.5 ng ml(-1) for 30 min before abrupt withdrawal or gradual withdrawal by 0.6 ng ml(-1) every five min. Pain was assessed at baseline, during infusion, 45-50 min and 105-110 min after end of infusions using the heat pain test (HPT) and the cold pressor test (CPT).
RESULTS
The HPT 45 min after infusion indicated OIH development in the abrupt withdrawal session with higher pain scores compared with the gradual withdrawal and placebo sessions (both P<0.01. Marginal mean scores: placebo 2.90; abrupt 3.39; gradual 2.88), but no OIH after gradual withdrawal compared with placebo (P=0.93). In the CPT 50 min after end of infusion there was OIH in both remifentanil sessions compared with placebo (gradual P=0.01, abrupt P<0.01. Marginal mean scores: placebo 4.56; abrupt 5.25; gradual 5.04). There were no differences between the three sessions 105-110 min after infusion.
CONCLUSIONS
We found no development of OIH after gradual withdrawal of remifentanil infusion in the HPT. After abrupt withdrawal OIH was present in the HPT. In the CPT there was OIH after both gradual and abrupt withdrawal of infusion. The duration of OIH was less than 105 min for both pain modalities.
CLINICAL TRIAL REGISTRATION
NCT 01702389. EudraCT number 2011-002734-39.
背景
本研究旨在探讨瑞芬太尼输注的逐渐停药是否能预防阿片类药物诱发的痛觉过敏（OIH），而不是突然停药。还评估了 OIH 持续时间。
方法
本研究纳入了 19 名志愿者，采用随机、双盲、安慰剂对照、交叉设计。所有志愿者均经历了三个阶段：瑞芬太尼输注的突然停药或逐渐停药和安慰剂。瑞芬太尼以 2.5ngml(-1)输注 30min 后，突然停药或每 5min 以 0.6ngml(-1)的速度逐渐停药。在基线、输注期间、输注结束后 45-50min 和 105-110min 时，使用热痛测试（HPT）和冷加压测试（CPT）评估疼痛。
结果
输注后 45min 的 HPT 显示，在突然停药阶段，与逐渐停药和安慰剂阶段相比，疼痛评分更高，表明 OIH 发展（均 P<0.01。边缘均数评分：安慰剂 2.90；突然停药 3.39；逐渐停药 2.88），但逐渐停药后与安慰剂相比无 OIH（P=0.93）。输注结束后 50min 的 CPT 显示，与安慰剂相比，瑞芬太尼两个阶段均有 OIH（逐渐停药 P=0.01，突然停药 P<0.01。边缘均数评分：安慰剂 4.56；突然停药 5.25；逐渐停药 5.04）。输注后 105-110min 三个阶段之间无差异。
结论
我们发现，瑞芬太尼输注逐渐停药后，HPT 中未出现 OIH。突然停药后，HPT 中出现 OIH。在 CPT 中，两种输注方式都有 OIH。两种疼痛模式的 OIH 持续时间均少于 105min。
临床试验注册号
NCT 01702389。EudraCT 编号 2011-002734-39。
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