Department of Anesthesiology and Pain Medicine, Ludwig-Maximilians-University Munich (LMU), Munich, Germany.
Statistical Consulting Unit StaBLab, Department of Statistics, LMU Munich, Munich, Germany.
Pain. 2020 Feb;161(2):266-273. doi: 10.1097/j.pain.0000000000001713.
Insufficient perioperative pain treatment is known as a highly predictive risk factor for the development of chronic postoperative pain. Remifentanil is an ultrashort-acting opioid that provides quick and efficient analgesia but is associated with the induction of opioid-induced hyperalgesia. Despite these well-known characteristics, this substance is being increasingly used in anesthesia and in a variety of medical fields, such as intensive-care medicine and obstetrics. The aim of our study was to reveal whether remifentanil influences postoperative pain, the requirement for postoperative analgesics, and requirement of antiemetics (as indirect indicator of postoperative nausea and vomiting), as well as the effects on time to extubation and length of stay in the postanesthesia care unit in daily clinical routine. From an electronic medical records database of 55,693 anesthesias, we analyzed data from all patients receiving intraabdominal surgery (visceral, gynecological, and urological) under general anesthesia or combined general-epidural anesthesia by propensity score matching. The administration of remifentanil was associated with higher postoperative pain scores despite a higher requirement of postoperative analgesics. Additional epidural analgesia was not able to avoid this finding. The intraoperative use of remifentanil is associated with a deterioration of pain levels and postoperative analgesic requirement, wherefore the potential benefit of this substance seems to be outweighed by its potential disadvantages. Especially in operative procedures in which high postoperative pain scores are expected, the unreflective use should be critically questioned.
围手术期疼痛治疗不足是慢性术后疼痛发展的一个高度预测性风险因素。瑞芬太尼是一种超短效阿片类药物，能提供快速有效的镇痛效果，但与阿片类药物诱导的痛觉过敏有关。尽管有这些众所周知的特点，但这种物质在麻醉学中以及重症医学和妇产科等多种医学领域中的使用越来越多。我们的研究目的是揭示瑞芬太尼是否会影响术后疼痛、术后镇痛药物的需求以及止吐药的需求（作为术后恶心和呕吐的间接指标），以及对拔管时间和麻醉后恢复室停留时间的影响在日常临床常规中。我们从一个 55693 例麻醉的电子病历数据库中，通过倾向评分匹配分析了所有接受全身麻醉或联合全身-硬膜外麻醉下腹部手术（内脏、妇科和泌尿科）的患者的数据。尽管术后镇痛药物的需求更高，但瑞芬太尼的给药与更高的术后疼痛评分相关。额外的硬膜外镇痛并不能避免这一发现。瑞芬太尼在术中的使用与疼痛程度和术后镇痛需求的恶化有关，因此，这种物质的潜在益处似乎超过了其潜在的缺点。特别是在预期术后疼痛评分较高的手术中，应慎重考虑其盲目使用。
