Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.
Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, 27, Dongguk-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10326, South Korea.
J Anesth. 2022 Aug;36(4):506-513. doi: 10.1007/s00540-022-03085-0. Epub 2022 Jun 22.
Remifentanil is useful in balanced anesthesia; however, there is concern regarding opioid-induced hyperalgesia. The effect of remifentanil on rebound pain, characterized by hyperalgesia after peripheral nerve block has rarely been studied. This study evaluated whether intraoperative remifentanil infusion may increase postoperative analgesic requirement in patients receiving preoperative interscalene brachial plexus block (IBP).
Sixty-eight patients undergoing arthroscopic shoulder surgery under general anesthesia were randomly allocated to remifentanil (R) or control (C) group. Preoperative IBP with 0.5% ropivacaine 15 mL was performed in all patients. Intraoperative remifentanil was administered only in the R group. Postoperative pain was controlled using intravenous patient-controlled analgesia (IV-PCA) and rescue analgesics. The primary outcome was the dosage of fentanyl-nefopam IV-PCA infused over 24 h postoperatively. The secondary outcomes included the numeric rating scale (NRS) score recorded at 4-h intervals over 24 h, amount of rescue analgesics and total postoperative analgesics used over 24 h, occurrence of intraoperative hypotension, postoperative nausea and vomiting (PONV) and delirium.
The dosage of fentanyl-nefopam IV-PCA was significantly less in C group than R group for postoperative 24 h. Fentanyl 101 [63-158] (median [interquartile range]) µg was used in the C group, while fentanyl 161 [103-285] µg was used in the R group (median difference 64 µg, 95% CI 10-121 µg, P = 0.02). Nefopam 8.1 [5.0-12.6] mg was used in the C group, while nefopam 12.9 [8.2-22.8] mg was used in the R group (median difference 5.1 mg, 95% CI 0.8-9.7 mg, P = 0.02). The total analgesic consumption: the sum of PCA consumption and administered rescue analgesic dose, converted to morphine milligram equivalents, was higher in the R group than C group (median difference 10.9 mg, 95% CI 3.0-19.0 mg, P = 0.01). The average NRS score, the incidence of PONV and delirium, were similar in both groups. The incidence of intraoperative hypotension was higher in R group than C group (47.1% vs. 20.6%, P = 0.005).
Remifentanil administration during arthroscopic shoulder surgery in patients undergoing preoperative IBP increased postoperative analgesic consumption.
瑞芬太尼在平衡麻醉中很有用；然而，人们担心阿片类药物引起的痛觉过敏。瑞芬太尼对周围神经阻滞后出现的反弹痛（以痛觉过敏为特征）的影响很少被研究。本研究评估了在接受术前肩胛上神经丛阻滞（IBP）的患者中，术中输注瑞芬太尼是否会增加术后镇痛需求。
68 例行全身麻醉下关节镜肩关节手术的患者被随机分配至瑞芬太尼（R）组或对照组（C）组。所有患者均接受 0.5%罗哌卡因 15 mL 的术前 IBP。仅在 R 组中给予术中瑞芬太尼。术后疼痛采用静脉患者自控镇痛（IV-PCA）和解救镇痛药物控制。主要结局是术后 24 小时内输注的芬太尼-奈福泮 IV-PCA 的剂量。次要结局包括术后 24 小时内每 4 小时记录一次的数字评分量表（NRS）评分、24 小时内使用的解救镇痛药物和总术后镇痛药物的剂量、术中低血压的发生、术后恶心呕吐（PONV）和谵妄的发生。
C 组术后 24 小时内芬太尼-奈福泮 IV-PCA 的用量明显少于 R 组。C 组芬太尼用量为 101 [63-158]（中位数[四分位间距]）µg，R 组芬太尼用量为 161 [103-285]µg（中位数差异 64µg，95%CI 10-121µg，P=0.02）。C 组奈福泮用量为 8.1 [5.0-12.6]mg，R 组奈福泮用量为 12.9 [8.2-22.8]mg（中位数差异 5.1mg，95%CI 0.8-9.7mg，P=0.02）。R 组的总镇痛消耗量：PCA 消耗量和给予的解救镇痛剂量之和，转换为吗啡毫克当量，高于 C 组（中位数差异 10.9mg，95%CI 3.0-19.0mg，P=0.01）。两组的平均 NRS 评分、PONV 和谵妄的发生率相似。R 组术中低血压的发生率高于 C 组（47.1% vs. 20.6%，P=0.005）。
在接受术前 IBP 的行关节镜肩关节手术的患者中，瑞芬太尼的术中给药增加了术后镇痛的消耗。
