Department of Anaesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 13496, Korea.
Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea.
Br J Anaesth. 2017 Dec 1;119(6):1161-1168. doi: 10.1093/bja/aex253.
Intraoperative use of a high-dose remifentanil may induce postoperative hyperalgesia. Low-dose naloxone can selectively reverse some adverse effects of opioids without compromising analgesia. We thus hypothesized that the intraoperative use of a high-dose remifentanil combined with a low-dose naloxone infusion reduces postoperative hyperalgesia compared with the use of remifentanil alone.
Patients undergoing elective thyroid surgery were randomly assigned into one of three groups, depending on the intraoperative effect-site concentration of remifentanil, with or without a continuous infusion of naloxone: 4 ng ml-1 remifentanil with 0.05 μg kg-1 h-1 naloxone in the high-remifentanil with naloxone group, and 4 or 1 ng ml-1 remifentanil with a placebo in the high- or low-remifentanil groups, respectively. We measured the pain thresholds (primary outcome) to mechanical stimuli using von Frey filaments and incidence of hyperalgesia on the peri-incisional area 24 h after surgery. We also measured pain intensity, analgesic consumptions and adverse events up to 48 h after surgery.
The pain threshold presented as von Frey numbers [median (interquartile range)] was significantly lower in the high-remifentanil group (n=31) than in the high-remifentanil with naloxone (n=30) and the low-remifentanil (n=30) groups [3.63 (3.22-3.84) vs 3.84 (3.76-4.00) vs 3.80 (3.69-4.08), P=0.011]. The incidence of hyperalgesia was also higher in the high-remifentanil group than in the other groups [21/31 vs 10/30 vs 9/30, P=0.005]. Postoperative pain intensity, analgesic consumptions and adverse events were similar between groups.
The intraoperative use of low-dose naloxone combined with high-dose remifentanil reduced postoperative hyperalgesia but not pain.
NCT02856087.
术中使用高剂量瑞芬太尼可能会引发术后痛觉过敏。小剂量纳洛酮可以选择性地逆转阿片类药物的一些不良反应，而不会影响镇痛效果。因此，我们假设术中使用高剂量瑞芬太尼联合小剂量纳洛酮输注与单独使用瑞芬太尼相比，可减少术后痛觉过敏。
择期行甲状腺手术的患者随机分为三组，根据术中瑞芬太尼效应室浓度的不同，分别使用或不使用纳洛酮持续输注：高瑞芬太尼+纳洛酮组为瑞芬太尼 4ng/ml 加纳洛酮 0.05μg/kg/h，高瑞芬太尼组和低瑞芬太尼组的瑞芬太尼分别为 4 或 1ng/ml，同时给予安慰剂。我们使用 von Frey 纤维测量机械刺激的疼痛阈值（主要结局），并测量术后 24 小时切口周围区域痛觉过敏的发生率。我们还测量了术后 48 小时内的疼痛强度、镇痛药物的消耗和不良反应。
高瑞芬太尼组（n=31）的疼痛阈值表现为 von Frey 数字[中位数（四分位间距）]明显低于高瑞芬太尼+纳洛酮组（n=30）和低瑞芬太尼组（n=30）[3.63（3.22-3.84）vs 3.84（3.76-4.00）vs 3.80（3.69-4.08），P=0.011]。高瑞芬太尼组痛觉过敏的发生率也高于其他两组[21/31 vs 10/30 vs 9/30，P=0.005]。各组之间的术后疼痛强度、镇痛药物消耗和不良反应相似。
术中使用小剂量纳洛酮联合高剂量瑞芬太尼可减少术后痛觉过敏，但不减轻疼痛。
NCT02856087。
