Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences.
Department of Anesthesiology and Resuscitology, Okayama University Hospital.
Acta Med Okayama. 2022 Apr;76(2):187-193. doi: 10.18926/AMO/63413.
Remifentanil is an ultra-short-acting opioid that sometimes causes opioid-induced hyperalgesia, which has led to controversy regarding the association between intraoperative remifentanil administration and postoperative pain. This study aimed to assess the effects of the intraoperative remifentanil dose on postoperative pain. Patients undergoing esophageal, gastric/hepatobiliary, or intestinal/colon surgery and using postoperative patient-controlled epidural analgesia were analyzed. The patients were divided into two groups based on the average intraoperative remifentanil dose (high-dose remifentanil [HR] group: ≥0.1 μg/kg/min; low-dose remifentanil [LR] group: <0.1 μg/kg/min). In all, 406 patients met the inclusion criteria. A significant difference in the average dose of remifentanil was seen between the groups during the anesthesia period (0.14±0.05 vs. 0.07±0.02 μg/kg/min). However, no significant difference was seen in pre- or intraoperative patient characteristics. Numerical rating scale (NRS) scores on postoperative day 1 were similar between the groups (HR: 1.7±2.0; LR: 1.7±2.0; p=0.74). The incidence of poor pain control (NRS > 3/10) was also similar between the groups (HR: 14%; LR: 16%; p=0.57). Older age (> 60 years) and type of surgery (esophageal surgery) were associated with worse postoperative NRS scores. No significant association was seen between the intraoperative remifentanil dose and postoperative NRS scores following thoracoabdominal surgery with postoperative epidural pain management.
瑞芬太尼是一种超短效阿片类药物，有时会引起阿片类药物引起的痛觉过敏，这导致了术中瑞芬太尼给药与术后疼痛之间关联的争议。本研究旨在评估术中瑞芬太尼剂量对术后疼痛的影响。分析了接受食管、胃/肝胆或肠/结肠手术并使用术后患者自控硬膜外镇痛的患者。根据术中平均瑞芬太尼剂量将患者分为两组（高剂量瑞芬太尼[HR]组：≥0.1μg/kg/min；低剂量瑞芬太尼[LR]组：<0.1μg/kg/min）。共有 406 名患者符合纳入标准。麻醉期间两组间瑞芬太尼平均剂量有显著差异（0.14±0.05 比 0.07±0.02μg/kg/min）。然而，术前或术中患者特征无显著差异。术后第 1 天数字评分量表（NRS）评分两组间相似（HR：1.7±2.0；LR：1.7±2.0；p=0.74）。两组间疼痛控制不佳（NRS>3/10）的发生率也相似（HR：14%；LR：16%；p=0.57）。年龄较大（>60 岁）和手术类型（食管手术）与术后 NRS 评分较差相关。胸腹部手术后硬膜外疼痛管理与术中瑞芬太尼剂量与术后 NRS 评分之间无显著相关性。
