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Sung TY, Jee YS, Cho SA, Huh I, Lee SJ, Cho CK. Comparison of the effects of intraoperative remifentanil and sufentanil infusion on postoperative pain management in robotic gynecological surgery: a retrospective cohort study. Anesth Pain Med (Seoul) 2023; 18:376-381. [PMID: 37919921 PMCID: PMC10635855 DOI: 10.17085/apm.23007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 06/26/2023] [Accepted: 06/26/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Remifentanil and sufentanil are potent short-acting synthetic opioid analgesics. The administration of remifentanil has been associated with the incidence of opioid-induced hyperalgesia. Opioid-induced hyperalgesia may be alleviated when opioids, such as morphine, are switched to sufentanil. Therefore, this retrospective observational study aimed to compare the effects of remifentanil and sufentanil on postoperative pain in patients undergoing robotic gynecological surgery. METHODS We retrospectively analyzed the electronic medical records of patients who underwent elective robotic gynecological surgery between January 2016 and February 2021. The patients were classified into sufentanil (n = 159) or remifentanil (n = 359) groups according to the opioids administered continuously during anesthesia. The primary outcome assessed in this study was the postoperative pain score measured using the numeric rating scale (NRS). The secondary outcomes assessed included the recovery time (from discontinuation of opioid infusion to extubation) and frequency of rescue analgesic administration in the post-anesthesia care unit (PACU). RESULTS The recovery time did not differ significantly between the two groups. The NRS score for pain (median [1Q, 3Q]) in the PACU was significantly lower in the sufentanil group than in the remifentanil group (2 [2, 3] vs. 4 [3, 7], P < 0.001). The frequency of rescue analgesic administration in the PACU was 6.3% and 35.4% in the sufentanil and remifentanil groups, respectively (P < 0.001). CONCLUSIONS Sufentanil, as an adjunct to sevoflurane anesthesia is more advantageous than remifentanil in terms of postoperative pain control during robotic gynecological surgery.
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Affiliation(s)
- Tae-Yun Sung
- Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
- Myunggok Medical Research Center, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Young Seok Jee
- Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Sung-Ae Cho
- Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Inho Huh
- Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Seok-Jin Lee
- Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Choon-Kyu Cho
- Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
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Wu W, Zhou Y, Zhu Y, Liu J. Sufentanil target controlled infusion (TCI) versus remifentanil TCI for monitored anaesthesia care for patients with severe tracheal stenosis undergoing fiberoptic bronchoscopy: protocol for a prospective, randomised, controlled study. BMJ Open 2022; 12:e058662. [PMID: 36041770 PMCID: PMC9438080 DOI: 10.1136/bmjopen-2021-058662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The use of monitored anaesthesia care (MAC) is necessary and ubiquitous for fiberoptic bronchoscopy. Anaesthetic management of patients with severe tracheal stenosis has always been a challenge. The efficacy and safety of the MAC with sufentanil target controlled infusion (TCI) and remifentanil TCI in patients with severe tracheal stenosis are still unknown. METHODS ANALYSIS This study is a prospective, investigator-initiated, two-arm, randomised control trial to compare the efficacy and safety of sufentanil TCI with remifentanil TCI in patients with severe tracheal stenosis undergoing fiberoptic bronchoscopy. 270 patients will be randomly assigned to the sufentanil TCI group or remifentanil TCI group, with a 1:1 ratio in two groups. The primary outcome is the incidence of hypoxaemia (an oxygen saturation of <90%). The secondary outcome investigates the severity of hypoxaemia, cough severity, haemodynamic variables, sedation scores and satisfaction scores. ETHICS AND DISSEMINATION The study has been approved by the Medical Ethics Committee of Shanghai Pulmonary Hospital (approval No. K19-122). The results will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER ChiCTR2100043380.
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Affiliation(s)
- Wei Wu
- Department of Anaesthesiology, Shanghai Pulmonary Hospital, School of Medicine,Tongji University, Shanghai, China
| | - Yi Zhou
- School of Life Sciences and Technology, Tongji University, Shanghai, China
- Department of Anaesthesiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yuanjie Zhu
- Department of Anaesthesiology, Shanghai Pulmonary Hospital, School of Medicine,Tongji University, Shanghai, China
| | - Jianming Liu
- Department of Anaesthesiology, Shanghai Pulmonary Hospital, School of Medicine,Tongji University, Shanghai, China
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Su L, Bai X, Niu T, Zhuang X, Dong B, Wang G, Yu Y. P2Y1 purinergic receptor inhibition attenuated remifentanil-induced postoperative hyperalgesia via decreasing NMDA receptor phosphorylation in dorsal root ganglion. Brain Res Bull 2021; 177:352-362. [PMID: 34653560 DOI: 10.1016/j.brainresbull.2021.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Remifentanil-induced postoperative hyperalgesia is an intractable side effect of the clinical use of remifentanil, the mechanism of which remains obscure, especially in the peripheral nervous system. N-methyl-D-aspartate receptor (NMDAR) phosphorylation in dorsal root ganglion (DRG) plays a pronociceptive role in neuropathic pain. The contribution of the P2Y1 purinergic receptor (P2Y1R) in DRG to pain hypersensitivity derived from various origins and P2Y1R upregulation-induced NMDAR activation in neurons have also been uncovered. This study aimed to investigate whether P2Y1R participates in nociceptive processing in the DRG and spinal cord in remifentanil-induced postoperative hyperalgesia. METHODS Rats with remifentanil-induced postoperative hyperalgesia were intrathecally injected with NMDAR antagonist MK801 or P2Y1R antagonist MRS2179 at 10 min prior to remifentanil infusion. Mechanical allodynia, heat hyperalgesia, and cold hyperalgesia were measured at -24 h, 2 h, 6 h, 24 h, and 48 h following remifentanil infusion. The P2Y1R expression and NMDAR expression and phosphorylation in DRG ipsilateral to the incision were detected by Western blot and immunofluorescence. RESULTS Incision and remifentanil induced mechanical allodynia, heat hyperalgesia, and cold hyperalgesia accompanied by upregulated P2Y1R expression, increased NMDAR subunit NR1 expression and phosphorylation at Ser896, and NR2B expression and phosphorylation at Tyr1472 in DRG. Inhibition of NMDAR phosphorylation by MK801 effectively attenuated remifentanil-induced postoperative hyperalgesia. Furthermore, P2Y1R blockade by MRS2179 not only lessened remifentanil-evoked postoperative hypersensitivity to mechanical, heat, and cold stimuli, but also suppressed the increases in NR1 and NR2B expression and phosphorylation in DRG induced by incision and remifentanil. CONCLUSION The process by which P2Y1R mediates NMDAR expression and phosphorylation represents a mechanism of remifentanil-induced postoperative hyperalgesia in the DRG and/or spinal cord.
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Affiliation(s)
- Lin Su
- Department of Anesthesiology, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin 300052, PR China; Tianjin Research Institute of Anesthesiology, No. 154 Anshan Road, Heping District, Tianjin 300052, PR China
| | - Xiaoqing Bai
- Department of Science and Education, Tianjin Beichen Hospital, No. 7 Beiyi Road, Beichen District, Tianjin 300400, PR China
| | - Tongxiang Niu
- Tianjin Research Institute of Anesthesiology, No. 154 Anshan Road, Heping District, Tianjin 300052, PR China; Department of Anesthesiology, Tianjin Jinnan Hospital, No. 120 Jingu Road, Jinnan District, Tianjin 300350, PR China
| | - Xinqi Zhuang
- Tianjin Research Institute of Anesthesiology, No. 154 Anshan Road, Heping District, Tianjin 300052, PR China; Department of Anesthesiology, Tianjin Medical University Second Hospital, No. 23 Pingjiang Road, Hexi District, Tianjin 300211, PR China
| | - Beibei Dong
- Department of Anesthesiology, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin 300052, PR China; Tianjin Research Institute of Anesthesiology, No. 154 Anshan Road, Heping District, Tianjin 300052, PR China
| | - Guolin Wang
- Department of Anesthesiology, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin 300052, PR China; Tianjin Research Institute of Anesthesiology, No. 154 Anshan Road, Heping District, Tianjin 300052, PR China
| | - Yonghao Yu
- Department of Anesthesiology, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin 300052, PR China; Tianjin Research Institute of Anesthesiology, No. 154 Anshan Road, Heping District, Tianjin 300052, PR China.
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Massoth C, Schwellenbach J, Saadat-Gilani K, Weiss R, Pöpping D, Küllmar M, Wenk M. Impact of opioid-free anaesthesia on postoperative nausea, vomiting and pain after gynaecological laparoscopy - A randomised controlled trial. J Clin Anesth 2021; 75:110437. [PMID: 34229292 DOI: 10.1016/j.jclinane.2021.110437] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/22/2021] [Accepted: 06/26/2021] [Indexed: 01/02/2023]
Abstract
STUDY OBJECTIVE Opioid-free anaesthesia may enhance postoperative recovery by reducing opioid-related side effects such as nausea, hyperalgesia or tolerance. The objective was to investigate the impact of multimodal opioid-free general anaesthesia on postoperative nausea, vomiting, pain and morphine consumption compared to the traditional opioid-based approach. DESIGN This study was conducted as a prospective parallel-group randomised controlled trial. SETTING Perioperative Care. PATIENTS 152 adult women undergoing elective inpatient gynaecological laparoscopy. INTERVENTIONS Patients were randomly assigned for opioid-free anaesthesia (Group OF) with dexmedetomidine, esketamine and sevoflurane or to have opioid-based anaesthesia (Group C) with sufentanil and sevoflurane. MEASUREMENTS Primary outcome was the occurrence of nausea within 24 h after surgery. Patients were assessed for the incidence and severity of PONV, postoperative pain and morphine consumption and recovery characteristics. MAIN RESULTS Patients in both groups had comparable clinical and surgical data. 69.7% of patients in the control group and 68.4% of patients in the opioid-free group met the primary endpoint (OR 1.06, 95% Confidence Interval (CI) (0.53; 2.12) p = 0.86). The incidence of clinically important PONV defined by the PONV impact scale was 8.1% (Group C) vs 10.5% (OF); p = 0.57). Antiemetic requirements, pain scores and morphine consumption were equivalent in both groups. Postoperative sedation was significantly increased in group OF (p < 0.001), and the median length of stay at the post-anaesthesia care unit was 69.0 min (46.5-113.0) vs 50.0 (35.3-77.0) minutes in the control group (p < 0.001). CONCLUSIONS Opioid-free multimodal general anaesthesia is feasible but did not decrease the incidence of PONV, or reduce pain scores and morphine consumption compared to an opioid-containing anaesthetic regimen.
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Affiliation(s)
- Christina Massoth
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, A1, 48149 Münster, Germany.
| | - Judith Schwellenbach
- Department of Anesthesiology, Intensive Care and Pain Medicine, Florence-Nightingale-Hospital, Kreuzbergstraße 79, 40489 Düsseldorf, Germany
| | - Khaschayar Saadat-Gilani
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, A1, 48149 Münster, Germany
| | - Raphael Weiss
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, A1, 48149 Münster, Germany
| | - Daniel Pöpping
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, A1, 48149 Münster, Germany
| | - Mira Küllmar
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, A1, 48149 Münster, Germany
| | - Manuel Wenk
- Department of Anesthesiology, Intensive Care and Pain Medicine, Florence-Nightingale-Hospital, Kreuzbergstraße 79, 40489 Düsseldorf, Germany
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Wetterkamp M, Meiser A, Weber TP, Vogelsang H, Lange T, Trost M, Bellgardt M. Spontaneous breathing for managing analgesia during balanced anesthesia with remifentanil and desflurane: a prospective, single center randomized controlled trial. Med Gas Res 2021; 11:94-99. [PMID: 33942778 PMCID: PMC8174411 DOI: 10.4103/2045-9912.310606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The main goal of anesthesiology is to achieve the best level of analgesia and a fast recovery of consciousness following anesthesia. The preservation of spontaneous breathing during general anesthesia with anesthetic gases is practiced by many anesthetists. However, very few studies have dealt with these positive properties of volatile anesthetics such as sevoflurane or desflurane. Remifentanil is a very short half-life opiate that combines sufficient intra-operative analgesia with a fast post-operative recovery time. We tested the hypothesis that spontaneous breathing can reduce overdosing with remifentanil during desflurane anesthesia. In this prospective, single center, multiple anesthetist study, 30 patients were randomized into two groups (volume-controlled ventilation mode and spontaneous breathing). The spontaneous breathing group showed a significantly lower post-operative pain level than the volume-controlled ventilation mode group. Furthermore, less remifentanil as well as less piritramide was needed in the spontaneous breathing group compared with volume-controlled ventilation mode. It was possible to achieve spontaneous breathing in all patients with 0.6 minimum alveolar concentration desflurane, in order to control the remifentanil rate and prevent an overdose. All spontaneous breathing patients had low intra- and post-operative pain levels and the need for analgesics was equal to or lower than that in the volume-controlled ventilation mode group. By reducing the intra-operative amount of opiates, both the post-operative pain and the amount of post-operative analgesia required can be reduced. A balanced anesthesia with spontaneous intra-operative breathing is needed to determine the required amount of opiates. This study was approved by the Ethic Committee of the Ruhr-University of Bochum (approval No. 2435) in September, 2004.
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Affiliation(s)
- Mark Wetterkamp
- Department of Orthopedics and Traumatology, St. Josef-Hospital, Ruhr-University of Bochum, Bochum, Germany
| | - Andreas Meiser
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, Saarland University Medical Center, Homburg/Saar, Germany
| | - Thomas Peter Weber
- Department of Anesthesiology and Intensive Care Medicine, St. Josef-Hospital, Ruhr-University of Bochum, Bochum, Germany
| | - Heike Vogelsang
- Department of Anesthesiology and Intensive Care Medicine, St. Josef-Hospital, Ruhr-University of Bochum, Bochum, Germany
| | - Tobias Lange
- Department of Orthopedics and Traumatology, St. Josef-Hospital, Ruhr-University of Bochum, Bochum, Germany
| | - Matthias Trost
- Department of Orthopedics and Traumatology, St. Josef-Hospital, Ruhr-University of Bochum, Bochum, Germany
| | - Martin Bellgardt
- Department of Anesthesiology and Intensive Care Medicine, St. Josef-Hospital, Ruhr-University of Bochum, Bochum, Germany
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Berthoud V, Nguyen M, Appriou A, Ellouze O, Radhouani M, Constandache T, Grosjean S, Durand B, Gounot I, Bahr PA, Martin A, Nowobilski N, Bouhemad B, Guinot PG. Pupillometry pain index decreases intraoperative sufentanyl administration in cardiac surgery: a prospective randomized study. Sci Rep 2020; 10:21056. [PMID: 33273644 PMCID: PMC7713228 DOI: 10.1038/s41598-020-78221-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/20/2020] [Indexed: 11/09/2022] Open
Abstract
Pupillometry has proven effective for the monitoring of intraoperative analgesia in non-cardiac surgery. We performed a prospective randomized study to evaluate the impact of an analgesia-guided pupillometry algorithm on the consumption of sufentanyl during cardiac surgery. Fifty patients were included prior to surgery. General anesthesia was standardized with propofol and target-controlled infusions of sufentanyl. The standard group consisted of sufentanyl target infusion left to the discretion of the anesthesiologist. The intervention group consisted of sufentanyl target infusion based on the pupillary pain index. The primary outcome was the total intraoperative sufentanyl dose. The total dose of sufentanyl was lower in the intervention group than in the control group and (55.8 µg [39.7–95.2] vs 83.9 µg [64.1–107.0], p = 0.04). During the postoperative course, the cumulative doses of morphine (mg) were not significantly different between groups (23 mg [15–53] vs 24 mg [17–46]; p = 0.95). We found no significant differences in chronic pain at 3 months between the 2 groups (0 (0%) vs 2 (9.5%) p = 0.49). Overall, the algorithm based on the pupillometry pain index decreased the dose of sufentanyl infused during cardiac surgery. Clinical trial number: NCT03864016.
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Affiliation(s)
- Vivien Berthoud
- Anaesthesiology and Critical Care Department, Dijon University Hospital, 2 Bd Maréchal de Lattre de Tassigny, 21000, Dijon, France
| | - Maxime Nguyen
- Anaesthesiology and Critical Care Department, Dijon University Hospital, 2 Bd Maréchal de Lattre de Tassigny, 21000, Dijon, France.,LNC UMR1231, University of Burgundy Franche-Comté, 21000, Dijon, France
| | - Anouck Appriou
- Anaesthesiology and Critical Care Department, Dijon University Hospital, 2 Bd Maréchal de Lattre de Tassigny, 21000, Dijon, France
| | - Omar Ellouze
- Anaesthesiology and Critical Care Department, Dijon University Hospital, 2 Bd Maréchal de Lattre de Tassigny, 21000, Dijon, France
| | - Mohamed Radhouani
- Anaesthesiology and Critical Care Department, Dijon University Hospital, 2 Bd Maréchal de Lattre de Tassigny, 21000, Dijon, France
| | - Tiberiu Constandache
- Anaesthesiology and Critical Care Department, Dijon University Hospital, 2 Bd Maréchal de Lattre de Tassigny, 21000, Dijon, France
| | - Sandrine Grosjean
- Anaesthesiology and Critical Care Department, Dijon University Hospital, 2 Bd Maréchal de Lattre de Tassigny, 21000, Dijon, France
| | - Bastien Durand
- Anaesthesiology and Critical Care Department, Dijon University Hospital, 2 Bd Maréchal de Lattre de Tassigny, 21000, Dijon, France
| | - Isabelle Gounot
- Anaesthesiology and Critical Care Department, Dijon University Hospital, 2 Bd Maréchal de Lattre de Tassigny, 21000, Dijon, France
| | - Pierre-Alain Bahr
- Anaesthesiology and Critical Care Department, Dijon University Hospital, 2 Bd Maréchal de Lattre de Tassigny, 21000, Dijon, France
| | - Audrey Martin
- Anaesthesiology and Critical Care Department, Dijon University Hospital, 2 Bd Maréchal de Lattre de Tassigny, 21000, Dijon, France
| | - Nicolas Nowobilski
- Anaesthesiology and Critical Care Department, Dijon University Hospital, 2 Bd Maréchal de Lattre de Tassigny, 21000, Dijon, France
| | - Belaid Bouhemad
- Anaesthesiology and Critical Care Department, Dijon University Hospital, 2 Bd Maréchal de Lattre de Tassigny, 21000, Dijon, France.,LNC UMR1231, University of Burgundy Franche-Comté, 21000, Dijon, France
| | - Pierre-Grégoire Guinot
- Anaesthesiology and Critical Care Department, Dijon University Hospital, 2 Bd Maréchal de Lattre de Tassigny, 21000, Dijon, France. .,LNC UMR1231, University of Burgundy Franche-Comté, 21000, Dijon, France.
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Liu YH, Hu XB, Yang XM, Wang YW, Deng M. Comparing remifentanil and sufentanil in stress reduction during neurosurgery: a randomised controlled trial. Int J Clin Pharm 2020; 42:1326-1334. [PMID: 32686050 DOI: 10.1007/s11096-020-01094-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/01/2020] [Indexed: 12/01/2022]
Abstract
Background In most scenarios, anaesthesiologists titrate opioids to control nociceptive surgical stress based on intraoperative haemodynamic changes. Remifentanil was reported to cause more profound cardiovascular depression than sufentanil. A concern is that this direct cardiovascular depression might counteract the hypertension and tachycardia caused by surgical manipulation and mask inadequate analgesia. Objective To compare remifentanil and sufentanil, titrated to maintain a comparable haemodynamic range (within 20% of baseline) and combined with the same propofol regimen, in stress reduction measured as plasma levels of putative mediators of surgical stress. Setting Huashan Hospital of Fudan University, Shanghai, China. Method Forty-five patients undergoing supratentorial glioma resection were randomised to the remifentanil group or the sufentanil group. Main outcome measures Plasma concentrations of cortisol, epinephrine, norepinephrine, interleukin-6, interleukin-10 and lymphocyte counts were analysed before anaesthesia, 1 h after incision, at the end of surgery and 24 h after incision using enzyme-linked immunosorbent assay and an automatic haematology analyser. Recovery profiles during emergence from anaesthesia were also compared. Results Except for a lower epinephrine concentration in the remifentanil group 24 h after incision (median [interquartile range], 4.2 [3.4-6.1] vs. 8.4 [4.8-12.5] ng/ml; P = 0.003), stress biomarkers were not significantly different between the two groups. Patients in the sufentanil group had lower grades in coughing, restlessness (P = 0.001 and < 0.001, respectively) and a lower incidence of postoperative shivering (P = 0.007). Conclusion Compared to that of sufentanil, the direct cardiovascular depression of remifentanil does not mask the clinical manifestation of inadequate analgesia when both drugs are titrated according to haemodynamic variables in neurosurgery.
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Affiliation(s)
- Yi-Heng Liu
- Department of Anesthesiology, Huashan Hospital of Fudan University, No. 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Xiao-Bing Hu
- Department of Anesthesiology, Huashan Hospital of Fudan University, No. 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Xia-Min Yang
- Department of Anesthesiology, Huashan Hospital of Fudan University, No. 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Ying-Wei Wang
- Department of Anesthesiology, Huashan Hospital of Fudan University, No. 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Meng Deng
- Department of Anesthesiology, Huashan Hospital of Fudan University, No. 12 Middle Wulumuqi Road, Shanghai, 200040, China.
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Zhou J, Qi F, Hu Z, Zhang L, Li Z, Wang ZJ, Tang H, Chen Z. Dezocine attenuates the remifentanil-induced postoperative hyperalgesia by inhibition of phosphorylation of CaMKⅡα. Eur J Pharmacol 2020; 869:172882. [PMID: 31863769 DOI: 10.1016/j.ejphar.2019.172882] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 01/22/2023]
Abstract
Remifentanil, ultra-short-acting μ-opioid receptor agonist, has the greatest advantage in analgesia but could increase postoperative pain scores and induces postoperative hyperalgesia. Dezocine is a mixed opioid receptor partial agonist/antagonist and has been used for postoperative hyperalgesia management in clinical patients,but the potential molecular mechanism is still unclear. Ca2+/calmodulin-dependent protein kinase Ⅱ(CaMKⅡ) has been reported involved in remifentanil-induced hyperalgesia (RIH) in previous studies, but the relationship between CaMKⅡ and dezocine in RIH is still unclear. To investigate the mechanism of dezocine in RIH, we used a remifentanil induced postoperative hyperalgesia (RIPH) in incisional pain model of mouse. We subcutaneously infused remifentanil (40 μg/kg) to induce postoperative hyperalgesia. Dezocine (1.5 mg/kg, 3.0 mg/kg, and 6.0 mg/kg) was infused subcutaneously with remifentanil using the apparatus pump for 30 min. Paw withdrawal thermal latency (PWTL) and paw withdrawal mechanical threshold (PWMT) were used to assess thermal hyperalgesia and mechanical allodynia. Western blotting analysis and immunohistochemistry analysis were used to assess the expression of phosphorylated CaMKⅡα (p-CaMKⅡα) in somatosensory cortex, hippocampus and spinal cord. Subcutaneous infusion of remifentanil enhanced postoperative pain induced by surgical incision and increased PWTL and PWMT. Dezocine dose-dependently decreased the PWTL and PWMT in RIPH model. Correlating with behavioral effects, dezocine inhibited remifentanil-induced up-regulation of p-CaMKⅡα expression in somatosensory cortex, hippocampus and spinal cord. Dezocine could attenuate RIPH by suppressing p-CaMKⅡα.
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Affiliation(s)
- Jie Zhou
- Department of Anesthesiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, 310012, China; Department of Anesthesiology, Affiliated Hospital of Guilin Medical University, Gulin, Guangxi, 541004, China
| | - Fang Qi
- Department of Anesthesiology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Jingzhou, Hubei, 434020, China; Department of Anesthesiology, Affiliated Hospital of Guilin Medical University, Gulin, Guangxi, 541004, China
| | - Zhengqiang Hu
- Department of Pharmacology, School of Basic Medical Sciences, Zhejiang University, Hangzhou, Zhejiang, 310058, China
| | - Lejun Zhang
- Department of Pharmacology, School of Basic Medical Sciences, Zhejiang University, Hangzhou, Zhejiang, 310058, China
| | - Zigang Li
- Department of Anesthesiology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310006, China
| | - Zaijie Jim Wang
- Department of Biopharmaceutical Sciences, University of Illinois, Chicago, IL, 60607, USA
| | - Huifang Tang
- Department of Pharmacology, School of Basic Medical Sciences, Zhejiang University, Hangzhou, Zhejiang, 310058, China.
| | - Zhijun Chen
- Department of Anesthesiology, Wuhan NO. 1 Hospital, Wuhan, Hubei, 430022, China; Department of Anesthesiology, Affiliated Hospital of Guilin Medical University, Gulin, Guangxi, 541004, China.
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Acid-sensing ion channel 3 expression is increased in dorsal root ganglion, hippocampus and hypothalamus in remifentanil-induced hyperalgesia in rats. Neurosci Lett 2019; 721:134631. [PMID: 31734291 DOI: 10.1016/j.neulet.2019.134631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/31/2019] [Accepted: 11/13/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Remifentanil induces hyperalgesia, but the underlying mechanisms are not fully understood. Acid-sensing ion channel 3 (ASIC3) plays a regulatory role in the pain pathway. This study aimed to explore the effect of remifentanil administration on postoperative pain and on ASIC3 expression at the prespinal and supraspinal levels in a rat model. METHODS Rats were randomly allocated to the control, incision, remifentanil, and remifentanil + incision groups. Remifentanil was given by a 1-h intravenous infusion prior to plantar incision. Paw withdrawal mechanical threshold (PWMT) and paw withdrawal thermal latency (PWTL) were measured at different time points before and after incision to evaluate mechanical and thermal hyperalgesia, respectively. The dorsal root ganglion (DRG), hippocampus, and hypothalamus were obtained after sacrifice at 48 h post-incision for determination of the protein expression of ASIC3 using western blot. RESULTS Remifentanil administration significantly induced mechanical and thermal hyperalgesia from 2 to 48 h after incision. In addition, remifentanil exposure remarkably stimulated ASIC3 protein expression in DRG, hippocampus, and hypothalamus of rats at 48 h after incision. CONCLUSION Remifentanil-induced hyperalgesia is accompanied by increased ASIC3 expression at the DRG and supraspinal levels, implying a possible involvement of ASIC3 in remifentanil-induced hyperalgesia.
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Menezes DC, Vidal EIO, Costa CM, Mizubuti GB, Ho AMH, Barros GAM, Fukushima FB. [Sufentanil during anesthetic induction of remifentanil-based total intravenous anesthesia: a randomized controlled trial]. Rev Bras Anestesiol 2019; 69:327-334. [PMID: 31351679 DOI: 10.1016/j.bjan.2018.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 11/26/2018] [Accepted: 12/05/2018] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Postoperative pain represents an important concern when remifentanil is used for total intravenous anesthesia because of its ultrashort half-life. Longer acting opioids, such as sufentanil, have been used during induction of remifentanil-based total intravenous anesthesia as a means to overcome this shortcoming. However, the effectiveness and safety of such strategy still lacks evidence from randomized clinical trials. Hence, we aimed to assess the postoperative analgesic efficacy and safety of a single dose of sufentanil administered during the induction of remifentanil-based total intravenous anesthesia. METHODS Forty patients, scheduled for elective open abdominal surgery, were randomized to receive remifentanil-based total intravenous anesthesia with or without a single dose of sufentanil upon induction. We assessed the postoperative morphine consumption administered through a patient-controlled analgesia pump. Self-reported pain scores and the occurrence of nausea, vomiting, pruritus, agitation, somnolence and respiratory depression were also assessed up to 2 days after surgery. RESULTS The mean difference between the sufentanil and control groups regarding morphine consumption in the post-anesthetic care unit and at 12, 24 and 48h after surgery were -7.2mg (95%CI: -12.5 to -2.1, p<0.001), -3.9mg (95%CI: -11.9 to 4.7, p=0.26), -0.6mg (95%CI: (-12.7 to 12.7, p=0.80), and -1.8mg (95%CI: (-11.6 to 15.6, p=0.94), respectively. Neither self-reported pain nor the incidence of adverse events were significantly different between groups at any time point. CONCLUSION Our findings suggest that the administration of sufentanil during induction of remifentanil-based total intravenous anesthesia is associated with decreased early postoperative opioid consumption.
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Affiliation(s)
| | - Edison I O Vidal
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Departamento de Medicina Interna, Botucatu, SP, Brasil
| | - Cesar M Costa
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Departamento de Medicina Interna, Botucatu, SP, Brasil
| | - Glenio B Mizubuti
- Queen's University, Department of Anesthesiology and Perioperative Medicine, Kingston, Canadá
| | - Anthony M H Ho
- Queen's University, Department of Anesthesiology and Perioperative Medicine, Kingston, Canadá
| | - Guilherme A M Barros
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Departamento de Anestesiologia, Botucatu, SP, Brasil
| | - Fernanda B Fukushima
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Departamento de Anestesiologia, Botucatu, SP, Brasil.
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Menezes DC, Vidal EI, Costa CM, Mizubuti GB, Ho AM, Barros GA, Fukushima FB. [Sufentanil during anesthetic induction of remifentanil-based total intravenous anesthesia: a randomized controlled trial]. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2019; 69. [PMID: 31351679 PMCID: PMC9391889 DOI: 10.1016/j.bjane.2019.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Postoperative pain represents an important concern when remifentanil is used for total intravenous anesthesia because of its ultrashort half-life. Longer acting opioids, such as sufentanil, have been used during induction of remifentanil-based total intravenous anesthesia as a means to overcome this shortcoming. However, the effectiveness and safety of such strategy still lacks evidence from randomized clinical trials. Hence, we aimed to assess the postoperative analgesic efficacy and safety of a single dose of sufentanil administered during the induction of remifentanil-based total intravenous anesthesia. METHODS Forty patients, scheduled for elective open abdominal surgery, were randomized to receive remifentanil-based total intravenous anesthesia with or without a single dose of sufentanil upon induction. We assessed the postoperative morphine consumption administered through a patient-controlled analgesia pump. Self-reported pain scores and the occurrence of nausea, vomiting, pruritus, agitation, somnolence and respiratory depression were also assessed up to 2 days after surgery. RESULTS The mean difference between the sufentanil and control groups regarding morphine consumption in the post-anesthetic care unit and at 12, 24 and 48h after surgery were -7.2mg (95%CI: -12.5 to -2.1, p<0.001), -3.9mg (95%CI: -11.9 to 4.7, p=0.26), -0.6mg (95%CI: (-12.7 to 12.7, p=0.80), and -1.8mg (95%CI: (-11.6 to 15.6, p=0.94), respectively. Neither self-reported pain nor the incidence of adverse events were significantly different between groups at any time point. CONCLUSION Our findings suggest that the administration of sufentanil during induction of remifentanil-based total intravenous anesthesia is associated with decreased early postoperative opioid consumption.
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Affiliation(s)
| | - Edison I.O. Vidal
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Departamento de Medicina Interna, Botucatu, SP, Brazil
| | - Cesar M. Costa
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Departamento de Medicina Interna, Botucatu, SP, Brazil
| | - Glenio B. Mizubuti
- Queen's University, Department of Anesthesiology and Perioperative Medicine, Kingston, Canada
| | - Anthony M.H. Ho
- Queen's University, Department of Anesthesiology and Perioperative Medicine, Kingston, Canada
| | - Guilherme A.M. Barros
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Departamento de Anestesiologia, Botucatu, SP, Brazil
| | - Fernanda B. Fukushima
- Universidade Estadual Paulista (UNESP), Faculdade de Medicina de Botucatu, Departamento de Anestesiologia, Botucatu, SP, Brazil,Corresponding author.
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Peng Y, Zang T, Zhou L, Ni K, Zhou X. COX-2 contributed to the remifentanil-induced hyperalgesia related to ephrinB/EphB signaling. Neurol Res 2019; 41:519-527. [PMID: 30759061 DOI: 10.1080/01616412.2019.1580459] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background and Objectives: Studying the underlying mechanisms of opiate-induced hyperalgesia is fundamental to understanding and treating pain. Our previous study has proved that ephrinB/EphB signaling contributes to opiate-induced hyperagesia, but the manner in which ephrinB/EphB signaling acts on spinal nociceptive information networks to produce hyperalgesia remains unclear. Other studies have suggested that ephrinB/EphB signaling, NMDA receptor and COX-2 act together to participate in the modulation of nociceptive information processes at the spinal level. The objective of this research was to investigate the role of COX-2 in remifentanil-induced hyperalgesia and its relationship with ephrinB/EphB signaling. Methods: We characterized the remifentanil-induced pain behaviours by evaluating thermal hyperalgesia and mechanical allodynia in a mouse hind paw incisional model. Protein expression of COX-2 in spinal cord was assayed by western blotting and mRNA level of COX-2 was assayed by Real-time PCR (RT-PCR). Results: Continuing infusion of remifentanil produced thermal hyperalgesia and mechanical allodynia, which was accompanied by increased expression of spinal COX-2 protein and mRNA. This response was inhibited by pre-treatment with EphB2-Fc, an antagonist of ephrinB/EphB. SC58125 and NS398, inhibitors of COX-2, suppressed pain behaviours induced by remifentanil infusion and reversed the increased pain behaviours induced by intrathecal injection of ephrinB2-Fc, an agonist of ephrinB/EphB. Conclusions: Our findings confirmed that COX-2 is involved in remifentanil-induced hyperalgesia related to ephrinB/EphB signaling. EphrinB/EphB signaling might be the upstream of COX-2.
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Affiliation(s)
- Yunan Peng
- a Department of Anesthesiology , Affiliated Drum-Tower Hospital of Medical College of Nanjing University , Nanjing , Jiangsu Province , China
| | - Ting Zang
- a Department of Anesthesiology , Affiliated Drum-Tower Hospital of Medical College of Nanjing University , Nanjing , Jiangsu Province , China
| | - Luyang Zhou
- a Department of Anesthesiology , Affiliated Drum-Tower Hospital of Medical College of Nanjing University , Nanjing , Jiangsu Province , China
| | - Kun Ni
- a Department of Anesthesiology , Affiliated Drum-Tower Hospital of Medical College of Nanjing University , Nanjing , Jiangsu Province , China
| | - Xuelong Zhou
- b Department of Anesthesiology , First Affiliated Hospital of Nanjing Medical University , Nanjing , Jiangsu Province , China
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Ghezel-Ahmadi V, Ghezel-Ahmadi D, Schirren J, Tsapopiorgas C, Beck G, Bölükbas S. Perioperative systemic magnesium sulphate to minimize acute and chronic post-thoracotomy pain: a prospective observational study. J Thorac Dis 2019; 11:418-426. [PMID: 30962985 DOI: 10.21037/jtd.2019.01.50] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Thoracotomy leads to acute and chronic post-thoracotomy pain (CPTP). The purpose of this study was to investigate the effect of magnesium sulphate (MgSO4) administered perioperatively on acute postoperative and CPTP syndrome. Methods One hundred patients were enrolled in this prospective, observational study. Analgesic medication was provided according to the World Health Organization pain relief ladder (control group). The study group received additionally MgSO4 (40 mg/kg over 10 minutes) during induction of anesthesia followed by an infusion over 24 hours (10 mg/kg/h). The presence and severity of pain were assessed before surgery, on postsurgical days 1-8, 30 and 90, respectively. The Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) was used pre- and postoperatively for documentation of neuropathic pain. The incidence and severity of CPTP were assessed by a telephone survey 30 and 90 days after surgery. Results Numerical rating scale (NRS) pain scores at rest were significantly lower in the study group receiving MgSO4 at days 1 to 8 (P<0.05). Thirty days after surgery, 2.1% of the MgSO4-patients had a LANSS score ≥12 compared to 14.3% in the control group (P=0.031). No patient had a LANSS score ≥12 in the study group compared to the control group (0% vs. 12.2%, P<0.05) 90 days following surgery. Conclusions MgSO4 administration reduces postoperative pain at rest according to the NRS pain scores and is effective in preventing chronic neuropathic post-thoracotomy pain measured by LANSS score. Prospective-randomized trials are needed to confirm the results of the present study.
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Affiliation(s)
- Verena Ghezel-Ahmadi
- Department of Anesthesiology and Critical Care Medicine, HELIOS Dr. Horst Schmidt Kliniken, Wiesbaden, Germany
| | - David Ghezel-Ahmadi
- Department of Anesthesiology and Critical Care Medicine, HELIOS Dr. Horst Schmidt Kliniken, Wiesbaden, Germany
| | - Joachim Schirren
- Department of Thoracic Surgery, AGAPLESION Markus Krankenhaus, Frankfurt, Germany
| | | | - Grietje Beck
- Department of Anesthesiology and Critical Care Medicine, HELIOS Dr. Horst Schmidt Kliniken, Wiesbaden, Germany
| | - Servet Bölükbas
- Department of Thoracic Surgery, Kliniken Essen-Mitte, Essen, Germany
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The Mechanism of Hyperalgesia and Anxiety Induced by Remifentanil: Phosphorylation of GluR1 Receptors in the Anterior Cingulate Cortex. J Mol Neurosci 2018; 65:93-101. [DOI: 10.1007/s12031-018-1072-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 04/20/2018] [Indexed: 01/21/2023]
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Shi C, Liu Y, Zhang W, Lei Y, Lu C, Sun R, Sun Y, Jiang M, Gu X, Ma Z. Intraoperative electroacupuncture relieves remifentanil-induced postoperative hyperalgesia via inhibiting spinal glial activation in rats. Mol Pain 2018; 13:1744806917725636. [PMID: 28825338 PMCID: PMC5570117 DOI: 10.1177/1744806917725636] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Accumulating studies have suggested that remifentanil, the widely-used opioid analgesic in clinical anesthesia, can activate the pronociceptive systems and enhance postoperative pain. Glial cells are thought to be implicated in remifentanil-induced hyperalgesia. Electroacupuncture is a complementary therapy to relieve various pain conditions with few side effects, and glial cells may be involved in its antinociceptive effect. In this study, we investigated whether intraoperative electroacupuncture could relieve remifentanil-induced postoperative hyperalgesia by inhibiting the activation of spinal glial cells, the production of spinal proinflammatory cytokines, and the activation of spinal mitogen-activated protein kinases. Methods A rat model of remifentanil-induced postoperative hyperalgesia was used in this study. Electroacupuncture during surgery was conducted at bilateral Zusanli (ST36) acupoints. Behavior tests, including mechanical allodynia and thermal hyperalgesia, were performed at different time points. Astrocytic marker glial fibrillary acidic protein, microglial marker Iba1, proinflammatory cytokines, and phosphorylated mitogen-activated protein kinases in the spinal cord were detected by Western blot and/or immunofluorescence. Results Mechanical allodynia and thermal hyperalgesia were induced by both surgical incision and remifentanil infusion, and remifentanil infusion significantly exaggerated and prolonged incision-induced pronociceptive effects. Glial fibrillary acidic protein, Iba1, proinflammatory cytokines (interleukin-1β and tumor necrosis factor-α), and phosphorylated mitogen-activated protein kinases (p-p38, p-JNK, and p-ERK1/2) were upregulated after surgical incision, remifentanil infusion, and especially after their combination. Intraoperative electroacupuncture significantly attenuated incision- and/or remifentanil-induced pronociceptive effects, spinal glial activation, proinflammatory cytokine upregulation, and phosphorylated mitogen-activated protein kinase upregulation. Conclusions Our study suggests that remifentanil-induced postoperative hyperalgesia can be relieved by intraoperative electroacupuncture via inhibiting the activation of spinal glial cells, the upregulation of spinal proinflammatory cytokines, and the activation of spinal mitogen-activated protein kinases.
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Affiliation(s)
- Changxi Shi
- 1 Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province, China.,2 Department of Anesthesiology, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing University of Chinese Medicine, Jiangsu Province, China
| | - Yue Liu
- 3 Department of Anesthesiology, Drum Tower Hospital, Medical School of Nanjing University, Jiangsu Province, China
| | - Wei Zhang
- 3 Department of Anesthesiology, Drum Tower Hospital, Medical School of Nanjing University, Jiangsu Province, China
| | - Yishan Lei
- 3 Department of Anesthesiology, Drum Tower Hospital, Medical School of Nanjing University, Jiangsu Province, China
| | - Cui'e Lu
- 3 Department of Anesthesiology, Drum Tower Hospital, Medical School of Nanjing University, Jiangsu Province, China
| | - Rao Sun
- 3 Department of Anesthesiology, Drum Tower Hospital, Medical School of Nanjing University, Jiangsu Province, China
| | - Yu'e Sun
- 3 Department of Anesthesiology, Drum Tower Hospital, Medical School of Nanjing University, Jiangsu Province, China
| | - Ming Jiang
- 3 Department of Anesthesiology, Drum Tower Hospital, Medical School of Nanjing University, Jiangsu Province, China
| | - Xiaoping Gu
- 3 Department of Anesthesiology, Drum Tower Hospital, Medical School of Nanjing University, Jiangsu Province, China
| | - Zhengliang Ma
- 3 Department of Anesthesiology, Drum Tower Hospital, Medical School of Nanjing University, Jiangsu Province, China
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Lu A, Lei H, Li L, Lai L, Liang W, Xu S. Role of mitochondrial Ca2+uniporter in remifentanil-induced postoperative allodynia. Eur J Neurosci 2018; 47:305-313. [PMID: 29363836 DOI: 10.1111/ejn.13842] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 01/16/2018] [Accepted: 01/17/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Aizhu Lu
- Department of Anesthesiology; Zhujiang Hospital; Southern Medical University; No.253 Gongye Ave Guangzhou Guangdong China
- University of Ottawa Heart Institute & Department of Cellular and Molecular Medicine; University of Ottawa; Ottawa ON Canada
| | - Hongyi Lei
- Department of Anesthesiology; Zhujiang Hospital; Southern Medical University; No.253 Gongye Ave Guangzhou Guangdong China
| | - Le Li
- Department of Anesthesiology; Zhujiang Hospital; Southern Medical University; No.253 Gongye Ave Guangzhou Guangdong China
| | - Luying Lai
- Department of Anesthesiology; Zhujiang Hospital; Southern Medical University; No.253 Gongye Ave Guangzhou Guangdong China
| | - Wenbin Liang
- University of Ottawa Heart Institute & Department of Cellular and Molecular Medicine; University of Ottawa; Ottawa ON Canada
| | - Shiyuan Xu
- Department of Anesthesiology; Zhujiang Hospital; Southern Medical University; No.253 Gongye Ave Guangzhou Guangdong China
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Liu A, Wang X, Wang H, Lv G, Li Y, Li H. Δ-opioid receptor inhibition prevents remifentanil-induced post-operative hyperalgesia via regulating GluR1 trafficking and AMPA receptor function. Exp Ther Med 2017; 15:2140-2147. [PMID: 29434817 DOI: 10.3892/etm.2017.5652] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 09/13/2017] [Indexed: 01/11/2023] Open
Abstract
The interaction of remifentanil with glutamate systems has an important role in remifentanil-induced thermal and mechanical hyperalgesia. A previous study by our group suggested that the trafficking and function of glutamate receptor 1 (GluR1) subunits contributes to remifentanil-induced hyperalgesia by regulating the phosphorylation of GluR1 in dorsal horn neurons. The present study demonstrated that δ opioid receptor (DOR) inhibition prevented thermal and mechanical hyperalgesia, which was induced by remifentanil infusion via attenuating GluR1 subunit trafficking and α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR) function in dorsal horn neurons. Sprague Dawley rats received a plantar incision and remifentanil infusion to induce a model of postoperative hyperalgesia. Thermal and mechanical pain was tested at 8 different time-points. Expression of AMPAR subunits GluR1 and DOR, as well as the phosphorylation status of GluR1 were evaluated by western blot analysis. Furthermore, the function of AMPAR in the spinal dorsal horn was measured by whole-cell patch-clamp recording. Remifentanil-induced thermal and mechanical hyperalgesia appeared after the 60-min infusions, reaching a peak level on day 2 and persisting for 5 days. Remifentanil infusion led to upregulation of membrane expression of the AMPAR subunit GluR1 and DOR (P=0.003 and 0.001, respectively) no change in total GluR1 and DOR expression levels (P=0.244 and 0.531, respectively). Selective DOR inhibitor naltrindole caused a reduction of remifentanil-induced hyperalgesia, which was accompanied by downregulation of membrane levels of GluR1 in the spinal cord (P=0.0013). In addition, DOR inhibition led to downregulation of GluR1 phosphorylated at Ser845. Furthermore, the AMPAR-mediated miniature excitatory post-synaptic current was increased in frequency and in amplitude in dorsal horn neurons (P=0.002 and 0.0011, respectively), which was decreased by incubation with naltrindole. Combined behavioral, western blot and electrophysiological evidence indicated that remifentanil-induced hyperalgesia was mediated by DOR activation, followed by phosphorylation-dependent GluR1 trafficking and AMPAR function enhancement in the spinal cord. DOR appears to be required for remifentanil and incision-induced hyperalgesia development and to be a potential biochemical target for treating opioid-induced postoperative hyperalgesia.
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Affiliation(s)
- Aifen Liu
- Department of Anesthesiology, The Second Hospital Affiliated to Tianjin Medical University, Tianjin 300042, P.R. China
| | - Xiaopeng Wang
- Department of Anesthesiology, Shanxi Academy of Medical Science, Shanxi Dayi Hospital, Taiyuan, Shanxi 030032, P.R. China
| | - Hui Wang
- Department of General Surgery, Tianjin Public Security Hospital, Tianjin 300042, P.R. China
| | - Guoyi Lv
- Department of Anesthesiology, The Second Hospital Affiliated to Tianjin Medical University, Tianjin 300042, P.R. China
| | - Yize Li
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Hongmei Li
- Department of Anesthesiology, The Second Hospital Affiliated to Tianjin Medical University, Tianjin 300042, P.R. China
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Pan JR, Cai J, Zhou SL, Zhu QQ, Huang F, Zhang YH, Chi XJ, Hei ZQ. Pharmacodynamic analysis of target-controlled infusion of propofol in patients with hepatic insufficiency. Biomed Rep 2017; 5:693-698. [PMID: 28101342 DOI: 10.3892/br.2016.786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 09/16/2016] [Indexed: 12/27/2022] Open
Abstract
The effect of liver dysfunction on target-controlled infusion (TCI) of propofol remains poorly documented. The pharmacodynamic performance of propofol TCI was evaluated in a cohort of Chinese patients with hepatic insufficiency. Fifty-three patients with hepatic insufficiency were enrolled in the current prospective, observational study. Anesthesia was induced with propofol via TCI to a plasma concentration of 3 µg/ml. Following loss of consciousness (LOC), fentanyl and cisatracurium were administered. Pharmacodynamic parameters were recorded during TCI, including time to LOC, bispectral index (BIS), heart rate (HR) and blood pressure. Patients were divided into two groups based on model of end stage liver disease (MELD) score: Those with a MELD score of ≤9 and those with a MELD score of ≥10. BIS, mean arterial pressure and HR were demonstrated to vary according to time, but were not affected by liver dysfunction. Hypotension was prominent in patients with a MELD score of ≥10 30 min after induction. The proportion of bradycardia and hypotension at the other time points was not significantly different between MELD scores of ≤9 and ≥10. Notably, no bradycardia was observed in MELD of ≥10. Thus, bradycardia and hypotension was observed in patients with hepatic insufficiency over time, although patients with different severities of hepatic insufficiency did not present with different depths of anesthesia. TCI of propofol to 3 µg/ml may be not suitable for patients with hepatic insufficiency, particularly those with severe liver dysfunction. Predictive concentrations (Cp) of TCI propofol requires further investigation and adjustment in patients with hepatic insufficiency (trial registration no. ChiCTR-OCH-12002255).
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Affiliation(s)
- Jing-Ru Pan
- Department of Anesthesiology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Jun Cai
- Department of Anesthesiology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Shao-Li Zhou
- Department of Anesthesiology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Qian-Qian Zhu
- Department of Anesthesiology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Fei Huang
- Department of Anesthesiology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Yi-Han Zhang
- Department of Anesthesiology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Xin-Jin Chi
- Department of Anesthesiology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Zi-Qing Hei
- Department of Anesthesiology, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510630, P.R. China
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Effective Target Concentration of Sufentanil Combined With Sevoflurane Anesthesia for Abdominal Surgery: A Dose-Response Study. Int Surg 2017. [DOI: 10.9738/intsurg-d-14-00207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study was designed to investigate the effects of target-controlled infusion (TCI) of sufentanil with sevoflurane anesthesia on hemodynamics and postoperative recovery of abdominal surgery. Target-controlled infusion of opioid analgesics provides efficient drug use, allowing an accurate achievement of the desired analgesia level and fewer overdose-induced adverse effects. A total of 80 patients receiving abdominal surgery (surgery for gastric cancer or colorectal cancer) were divided into 4 groups to receive anesthesia with sevoflurane accompanied with different doses of sufentanil (0.4, 0.6, 0.8, or 1.0 ng/mL). Systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, times to recovery of spontaneous respiration, eye opening, extubation, and orientation were recorded. Hemodynamic measurements were compared among groups. Comparison between the 2 groups of subjects was made with one-way analysis of variance (ANOVA), LSD-t test, or χ2 test. Although sufentanil at 0.8 and 1.0 ng/mL maintained stable perioperative hemodynamics, the higher dose was associated with increased incidence of bradycardia following intubation (10/19 cases, 52.6%; P < 0.05). Additionally, no differences were observed in the incidence of hypotension, hypertension, or tachycardia between groups (P > 0.05). Increased dose of sufentanil was associated with delayed postoperative recovery. These results demonstrate that TCI at 0.8 ng/mL sufentanil accompanied with sevoflurane anesthesia is a suitable anesthetic regimen for abdominal surgery.
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Bhavsar R, Ryhammer PK, Greisen J, Rasmussen LA, Jakobsen CJ. Remifentanil Compared With Sufentanil Does Not Enhance Fast-Track Possibilities in Cardiac Surgery—A Randomized Study. J Cardiothorac Vasc Anesth 2016; 30:1212-20. [DOI: 10.1053/j.jvca.2015.12.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Indexed: 11/11/2022]
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Sun J, Lin H, Feng X, Dong J, Ansong E, Xu X. A comparison of intrathecal magnesium and ketamine in attenuating remifentanil-induced hyperalgesia in rats. BMC Anesthesiol 2016; 16:74. [PMID: 27599837 PMCID: PMC5013621 DOI: 10.1186/s12871-016-0235-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 08/24/2016] [Indexed: 11/10/2022] Open
Abstract
Background Activation of NMDA receptors play an important role in the development of remifentanil-induced hyperalgesia. We hypothesized that in addition to ketamine, intrathecal MgSO4 could also relieve thermal and mechanical hyperalgesia in rats. Methods Initially, 24 Sprague–Dawley rats were divided into control group, remifentanil group, surgical incision group and remifentanil combined with surgical incision group to create an experimental model. Subsequently, 40 rats were divided into control group, model group, model group plus 100 μg MgSO4, 300 μg MgSO4 and 10 μg ketamine respectively. Paw withdrawal mechanical thresholds and paw withdrawal thermal latency tests were performed at −24 h, 2 h, 6 h, 24 h, 48 h, 72 h and 7 day after the surgical procedure. After behavior assessment on the 7th day, remifentanil was given again to ascertain whether or not NMDA antagonists could suppress the re-exposure of remifentanil-induced hyperalgesia. Results Remifentanil administration plus surgical incision induced significant postoperative hyperalgesia, as indicated by decreased paw withdrawal mechanical thresholds and paw withdrawal thermal latency to mechanical and thermal stimulation. In addition to ketamine, intrathecal MgSO4 (100, 300 μg) dose-dependently reduced remifentanil-induced mechanical and thermal hyperalgesia. Ketamine had less mechanical hyperalgesia in 6 h (p = 0.018), 24 h (p = 0.014) and 48 h (p = 0.011) than 300 μg MgSO4. There was no difference in inhibiting thermal hyperalgesia between the group ketamine and group MgSO4 (300 μg). The rats were given remifentanil again 7 days later after the first exposure of remifentanil. The hyperalgesic effect induced by re-exposure of remifentanil was not reversed in any groups of MgSO4 or ketamine. Conclusions In addition to ketamine, intrathecal administration of MgSO4 dose-dependently reduced remifentanil-induced hyperalgesia in a surgical incision mode. Re-exposure to remifentanil 1 week later again produced hyperalgesia, and this was not altered by the prior intrathecal treatments in any 4 groups treated with MgSO4 or ketamine. Electronic supplementary material The online version of this article (doi:10.1186/s12871-016-0235-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jiehao Sun
- Department of Anesthesiology, 1st Affiliated Hospital of Wenzhou Medical University, 1# shangcaicun, Wenzhou, 325000, China
| | - Hai Lin
- Department of Anesthesiology, 1st Affiliated Hospital of Wenzhou Medical University, 1# shangcaicun, Wenzhou, 325000, China.,Department of Anesthesiology and Pain medicine, 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaona Feng
- Department of Anesthesiology, 1st Affiliated Hospital of Wenzhou Medical University, 1# shangcaicun, Wenzhou, 325000, China
| | - Jiaojiao Dong
- Department of Anesthesiology, 1st Affiliated Hospital of Wenzhou Medical University, 1# shangcaicun, Wenzhou, 325000, China
| | - Emmanuel Ansong
- Department of Anesthesiology, 1st Affiliated Hospital of Wenzhou Medical University, 1# shangcaicun, Wenzhou, 325000, China
| | - Xuzhong Xu
- Department of Anesthesiology, 1st Affiliated Hospital of Wenzhou Medical University, 1# shangcaicun, Wenzhou, 325000, China.
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Wang Z, Yuan Y, Xie K, Tang X, Zhang L, Ao J, Li N, Zhang Y, Guo S, Wang G. PICK1 Regulates the Expression and Trafficking of AMPA Receptors in Remifentanil-Induced Hyperalgesia. Anesth Analg 2016; 123:771-81. [DOI: 10.1213/ane.0000000000001442] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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24
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Is Intraoperative Remifentanil Associated With Acute or Chronic Postoperative Pain After Prolonged Surgery? An Update of the Literature. Clin J Pain 2016; 32:726-35. [DOI: 10.1097/ajp.0000000000000317] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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25
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Zhao Q, Zhang L, Shu R, Wang C, Yu Y, Wang H, Wang G. Involvement of Spinal PKMζ Expression and Phosphorylation in Remifentanil-Induced Long-Term Hyperalgesia in Rats. Cell Mol Neurobiol 2016; 37:643-653. [PMID: 27380044 DOI: 10.1007/s10571-016-0401-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 06/27/2016] [Indexed: 10/21/2022]
Abstract
Up-regulation of GluN2B-containing N-methyl-D-aspartate receptors (NMDARs) expression and trafficking is the key mechanism for remifentanil-induced hyperalgesia (RIH), nevertheless, the signaling pathway and pivotal proteins involved in RIH remain equivocal. PKMζ, an isoform of protein kinase C (PKC), maintains pain memory storage in neuropathic pain and inflammatory pain, which plays a parallel role regulated by NMDARs in long-term memory trace. In the present study, Zeta Inhibitory Peptide (ZIP), a PKMζ inhibitor, and a selective GluN2B antagonist Ro-256981 are injected intrathecally before remifentanil infusion (1 μg kg-1 min-1 for 1 h, iv) in order to detect whether GluN2B contributes to RIH through affecting synthesis and activity of PKMζ in spinal dorsal horn. Nociceptive tests are measured by Paw withdrawal mechanical threshold (PWT) and paw withdrawal thermal latency (PWL). The L4-L6 segments of dorsal horn taken from rats with RIH are for determining expression of PKMζ and pPKMζ by Western blot and immunohistochemistry. Our data suggest that remifentanil infusion causes an increase of PKMζ in expression and phosphorylation in rats with nociceptive sensitization, beginning at 2 h, peaked at 2 days, and returned to basal level at 7 days. ZIP (10 ng) could block behavioral sensitization induced by remifentanil. Ro25-6981 dosage-dependently attenuated mechanical and thermal hyperalgesia and reversed expression of PKMζ and pPKMζ, indicating that GluN2B-containing NMDA receptor facilitates development of RIH through mediating expression and activity of spinal PKMζ in rats. Although detailed mechanisms require further comprehensive study, the preventive role of Ro25-6981 and ZIP provide novel options for the effective precaution of RIH in clinics.
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Affiliation(s)
- Qi Zhao
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, 300052, China.,Tianjin Research Institute of Anesthesiology, Tianjin, 300052, China
| | - Linlin Zhang
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, 300052, China.,Tianjin Research Institute of Anesthesiology, Tianjin, 300052, China
| | - Ruichen Shu
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, 300052, China.,Tianjin Research Institute of Anesthesiology, Tianjin, 300052, China
| | - Chunyan Wang
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, 300052, China.,Tianjin Research Institute of Anesthesiology, Tianjin, 300052, China
| | - Yonghao Yu
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, 300052, China.,Tianjin Research Institute of Anesthesiology, Tianjin, 300052, China
| | - Haiyun Wang
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, 300052, China.,Tianjin Research Institute of Anesthesiology, Tianjin, 300052, China
| | - Guolin Wang
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, 300052, China. .,Tianjin Research Institute of Anesthesiology, Tianjin, 300052, China.
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Abstract
The use of opioids may seem to be a double-edged sword; they provide straight analgesic and antihyperalgesic effects initially, but subsequently are associated with the expression of acute opioid tolerance (AOT) and opioid-induced hyperalgesia (OIH) that have been reported in experimental studies and clinical observations. It has been suggested that opioids can induce an acute tolerance and hyperalgesia in dose- and/or time-dependent manners even when used within the clinically accepted doses. Recently, remifentanil has been used for pain management in clinical anesthesia and in the intensive care units because of its rapid onset and offset. We reviewed articles analyzing AOT and/or OIH by remifentanil and focused on the following issues: (1) evidence of remifentanil inducing AOT and/or OIH and (2) importance of AOT and/or OIH in considering the reduction of remifentanil dosage or adopting preventive modulations. Twenty-four experimental and clinical studies were identified using electronic searches of MEDLINE (PubMed, Ovid, Springer, and Elsevier). However, the development of AOT and OIH by remifentanil administration remains controversial. There is no sufficient evidence to support or refute the existence of OIH in humans.
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27
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Efficacy of Continuous S(+)-Ketamine Infusion for Postoperative Pain Control: A Randomized Placebo-Controlled Trial. Anesthesiol Res Pract 2016; 2016:6918327. [PMID: 26949390 PMCID: PMC4755104 DOI: 10.1155/2016/6918327] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 01/10/2016] [Indexed: 11/23/2022] Open
Abstract
Aim. A double-blind, randomized, placebo-controlled trial was designed to evaluate the efficacy of continuous intraoperative infusion of S(+)-ketamine under intravenous anesthesia with target-controlled infusion of remifentanil and propofol for postoperative pain control. Methods. Forty-eight patients undergoing laparoscopic cholecystectomy were assigned to receive continuous S(+)-ketamine infusion at a rate of 0.3 mg·kg−1·h−1 (n = 24, intervention group) or an equivalent volume of saline at the same rate (n = 24, placebo group). The same target-controlled intravenous anesthesia was induced in both groups. Pain was assessed using a 0 to 10 verbal numeric rating scale during the first 12 postoperative hours. Pain scores and morphine consumption were recorded in the postanesthesia care unit (PACU) and at 4 and 12 hours after surgery. Results. Pain scores were lower in the intervention group at all time points. Morphine consumption did not differ significantly between groups during PACU stay, but it was significantly lower in the intervention group at each time point after PACU discharge (P = 0.0061). At 12 hours after surgery, cumulative morphine consumption was also lower in the intervention group (5.200 ± 2.707) than in the placebo group (7.525 ± 1.872). Conclusions. Continuous S(+)-ketamine infusion during laparoscopic cholecystectomy under target-controlled intravenous anesthesia provided better postoperative pain control than placebo, reducing morphine requirement. Trial Registration. This trial is registered with ClinicalTrials.gov NCT02421913.
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Wu L, Huang X, Sun L. The efficacy of N-methyl-d-aspartate receptor antagonists on improving the postoperative pain intensity and satisfaction after remifentanil-based anesthesia in adults: a meta-analysis. J Clin Anesth 2015; 27:311-24. [DOI: 10.1016/j.jclinane.2015.03.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 03/05/2015] [Indexed: 10/23/2022]
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29
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Jiang M, Zhang W, Cheng C, Ma Z, Gu X. Intrathecal injection of KN93 attenuates paradoxical remifentanil-induced postoperative hyperalgesia by inhibiting spinal CaMKII phosphorylation in rats. Pharmacol Biochem Behav 2015; 134:35-41. [PMID: 25937575 DOI: 10.1016/j.pbb.2015.04.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 04/08/2015] [Accepted: 04/17/2015] [Indexed: 10/23/2022]
Abstract
AIMS Remifentanil is a short-acting and highly selective mu opiate agonist that is used in many clinical surgical situations for intraoperative pain relief. Under certain conditions, remifentanil can produce "paradoxical" hyperalgesia. This study aims to investigate mechanisms of actions mediating this "paradoxical" effect. METHODS Sprague-Dawley rats were divided into 6 groups including control and treatment groups. The paw withdrawal mechanical threshold and the paw withdrawal thermal latency of the rats were tested. The changes of rat behaviors were measured at 24h before intrathecal injection and at 2h, 6h, 24h, and 48h after operation. According to the changes in behavioral indicators of pain, the specimens of all groups were collected at 2h, 6h, 24h, and 48h after the operation. The level of calcium/calmodulin-dependent protein kinase II (CaMKII) phosphorylation in the spinal dorsal horn was analyzed by Western blotting. RESULTS Intraoperative infusion of remifentanil induced postoperative hyperalgesia in the rats. Intrathecal KN93 injection increased nociceptive thresholds of paw withdrawal mechanical threshold and paw withdrawal thermal latency in a dose-dependent manner. Western blotting results showed that CaMKII phosphorylation in the spinal dorsal horn was increased significantly by remifentanil. Inhibition of CaMKII phosphorylation relieved the hyperalgesia pain state. CONCLUSIONS Intrathecal injection of KN93 attenuates postoperative hyperalgesia induced by intraoperative infusion of remifentanil in rats through inhibiting spinal CaMKII phosphorylation.
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Affiliation(s)
- Ming Jiang
- Department of Anesthesiology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, PR China
| | - Wei Zhang
- Department of Anesthesiology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, PR China
| | - Chongxue Cheng
- Department of Anesthesiology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, PR China
| | - Zhengliang Ma
- Department of Anesthesiology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, PR China.
| | - Xiaoping Gu
- Department of Anesthesiology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, PR China.
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30
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Han SS, Do SH, Kim TH, Choi WJ, Yun JS, Ryu JH. Stepwise tapering of remifentanil at the end of surgery decreased postoperative pain and the need of rescue analgesics after thyroidectomy. BMC Anesthesiol 2015; 15:46. [PMID: 25927221 PMCID: PMC4404040 DOI: 10.1186/s12871-015-0026-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 03/20/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study was designed to investigate whether stepwise tapering of remifentanil at the end of surgery could decrease postoperative pain scores and requirements of rescue analgesics after remifentanil-desflurane anesthesia in patients with thyroidectomy. METHODS Sixty two patients undergoing thyroidectomy under general anesthesia were randomly allocated into two groups. All patients were anesthetised with desflurane and high-dose remifentanil. Remifentnail was infused at the rate of 0.3 μg/kg/min until the end of surgery in patients of the control group (group A) whereas remifentanil was tapered gradually from 0.3 to 0.1 μg/kg/min until the end of surgery for at least 30 minutes in patients with group B. Pain scores (0-100 numerical rating scale, NRS), rescue analgesic requirements and adverse events were assessed at 30 min, 2 h, 6 h, 12 h, and 24 h after operation. RESULTS There was a significant decrease in pain scores at 30 min (20 [0-80] vs. 50 [0-100], P = 0.002) and 2 h (30 [10-60] vs. 40 [20-80], P = 0.018) after surgery in group B compared with group A. In addition, rescue analgesics are less required in group B than in group A postoperatively (2 [1-3] vs. 3 [2,3], P = 0.039). There were no significant differences in adverse events between the two groups. CONCLUSIONS Tapering of remifentanil at the end of surgery decreased postoperative pain scores immediately after thyroidectomy with desflurane and high-dose remifentanil anesthesia. TRIAL REGISTRATION Clinical Research information Service (CRiS, registration number KCT0000589).
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Affiliation(s)
- Sun Sook Han
- Department of Anesthesiology & Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Sang Hwan Do
- Department of Anesthesiology & Pain Medicine, Seoul National University College of Medicine, Seoul, South Korea. .,Department of Anesthesiology & Pain Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea.
| | - Tae Hee Kim
- Department of Anesthesiology & Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Won Joon Choi
- Department of Anesthesiology & Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Ji Sup Yun
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Jung Hee Ryu
- Department of Anesthesiology & Pain Medicine, Seoul National University College of Medicine, Seoul, South Korea. .,Department of Anesthesiology & Pain Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea.
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31
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Lu C, Shi L, Zhang J, Kong M, Liu Y, Zhou Y, Xu L, He J, Ma Z, Gu X. Neuron-restrictive silencer factor in periaqueductal gray contributes to remifentanil-induced postoperative hyperalgesia via repression of the mu-opioid receptor. J Neurol Sci 2015; 352:48-52. [PMID: 25819118 DOI: 10.1016/j.jns.2015.03.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 03/10/2015] [Accepted: 03/11/2015] [Indexed: 01/16/2023]
Abstract
BACKGROUND The ultra-short-acting mu-opioid receptor (MOR) agonist remifentanil induces postoperative hyperalgesia both in preclinical and clinical research studies. However, the precise mechanisms remain unclear, although changes in opioid receptor expression might be a correlative feature. Neuron-restrictive silencer factor (NRSF) functions as a crucial regulator of MOR expression in specific neuronal cells. Using a mouse model of incisional postoperative pain, we assessed the expression of MOR and NRSF and investigated whether disruption of NRSF expression could prevent the postoperative nociceptive sensitization induced by surgical incision and subcutaneous infusion of remifentanil. METHODS Paw withdrawal mechanical threshold (PWMT) and paw withdrawal thermal latency (PWTL) were independently used to assess mechanical allodynia and thermal hyperalgesia after surgery and cerebral ventricle injection of NRSF antisense oligonucleotide. Western blotting analyses were preformed to assess the expression levels of MOR and NRSF. RESULTS NRSF expression levels were enhanced after intraoperative infusion of remifentanil, resulting in repression of MOR expression in the periaqueductal gray (PAG). NRSF blockade with an NRSF antisense oligonucleotide significantly enhanced the expression levels of MOR and alleviated mechanical allodynia and thermal hyperalgesia induced by intraoperative infusion of remifentanil. CONCLUSION NRSF functions as a negative regulator of MOR in PAG and contributes to remifentanil-induced postoperative hyperalgesia. NRSF in PAG may be a potential target for this pain therapy.
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Affiliation(s)
- Cui'e Lu
- Department of Anesthesiology, Affiliated Drum Tower Hospital of Medical College of Nanjing University, 321 Zhong Shan North Road, Nanjing 210008, Jiangsu Province, China.
| | - Linyu Shi
- Department of Anesthesiology, Affiliated Drum Tower Hospital of Medical College of Nanjing University, 321 Zhong Shan North Road, Nanjing 210008, Jiangsu Province, China.
| | - Juan Zhang
- Department of Anesthesiology, Affiliated Drum Tower Hospital of Medical College of Nanjing University, 321 Zhong Shan North Road, Nanjing 210008, Jiangsu Province, China.
| | - Mingjian Kong
- Drum Tower Clinical Medical College of Nanjing Medical University, Nanjing 210008, Jiangsu Province China.
| | - Yue Liu
- Department of Anesthesiology, Affiliated Drum Tower Hospital of Medical College of Nanjing University, 321 Zhong Shan North Road, Nanjing 210008, Jiangsu Province, China.
| | - Yu Zhou
- Department of Anesthesiology, Affiliated Drum Tower Hospital of Medical College of Nanjing University, 321 Zhong Shan North Road, Nanjing 210008, Jiangsu Province, China.
| | - Li Xu
- Department of Anesthesiology, Affiliated Drum Tower Hospital of Medical College of Nanjing University, 321 Zhong Shan North Road, Nanjing 210008, Jiangsu Province, China.
| | - Jianhua He
- Drum Tower Clinical Medical College of Nanjing Medical University, Nanjing 210008, Jiangsu Province China.
| | - Zhengliang Ma
- Department of Anesthesiology, Affiliated Drum Tower Hospital of Medical College of Nanjing University, 321 Zhong Shan North Road, Nanjing 210008, Jiangsu Province, China.
| | - Xiaoping Gu
- Department of Anesthesiology, Affiliated Drum Tower Hospital of Medical College of Nanjing University, 321 Zhong Shan North Road, Nanjing 210008, Jiangsu Province, China.
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32
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Angst MS. Intraoperative Use of Remifentanil for TIVA: Postoperative Pain, Acute Tolerance, and Opioid-Induced Hyperalgesia. J Cardiothorac Vasc Anesth 2015; 29 Suppl 1:S16-22. [PMID: 26025041 DOI: 10.1053/j.jvca.2015.01.026] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Martin S Angst
- Department of Anesthesia, Stanford University School of Medicine, Stanford, CA.
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33
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de Hoogd S, Ahlers SJGM, van Dongen EPA, Tibboel D, Dahan A, Knibbe CAJ. Remifentanil versus fentanyl during cardiac surgery on the incidence of chronic thoracic pain (REFLECT): study protocol for a randomized controlled trial. Trials 2014; 15:466. [PMID: 25429720 PMCID: PMC4258928 DOI: 10.1186/1745-6215-15-466] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 11/10/2014] [Indexed: 12/31/2022] Open
Abstract
Background Chronic thoracic pain after cardiac surgery is prevalent (11 to 56%) and may affect patients’ physical and mental health status. Despite its favorable pharmacokinetic and pharmacodynamic properties, high doses of remifentanil administered during surgery are reported to cause acute postoperative pain and increased requirements for analgesics. Recently, an association between remifentanil use and the incidence of chronic thoracic pain in the long term was also reported. Our objective is to investigate the influence of the intraoperative remifentanil on chronic postoperative pain in a prospective randomized controlled trial. Methods/design In this prospective, randomized, single-blind clinical trial, all patients (N =126) between 18 and 85 years undergoing cardiac surgery via sternotomy receive a continuous infusion of propofol together with intermittent intravenous fentanyl at predetermined times perioperatively. Patients are randomized to receive either an additional continuous infusion of remifentanil (0.15 μg-1kgIBW-1 min-1) or additional fentanyl (200 to 500 μg) as needed during surgery. The primary end point is the prevalence of chronic thoracic pain 12 months after surgery. Secondary end points include acute postoperative pain; postoperative analgesic use; chronic thoracic pain 3 and 6 months after surgery; quality of life (SF-12) at 3, 6 and 12 months after surgery; work productivity; and use of health care. In addition, thermal detection and pain thresholds are measured preoperatively, 3 days after surgery and 12 months after surgery using quantitative sensory testing (QST). Finally, the influence of several genetic variances on the different outcomes will be measured. Discussion Chronic thoracic pain is prevalent after cardiac surgery, and research is needed to minimize the risk of chronic persistent postoperative pain, which is an invalidating, long-term complication of surgery. The objective of this trial is to determine the influence of perioperative remifentanil on long-term pain outcomes for cardiac patients in a prospective randomized trial. The results may be used to optimize perioperative analgesia techniques and, thereby, improve quality of life after cardiac surgery. Trial registration Clinicaltrials.gov
NCT02031016 on 13 December 2013.
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Affiliation(s)
| | | | | | | | | | - Catherijne A J Knibbe
- Department of Clinical Pharmacy, St Antonius Hospital, Koekoeklaan 1, 3435 CM Nieuwegein, The Netherlands.
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Li YZ, Tang XH, Wang CY, Hu N, Xie KL, Wang HY, Yu YH, Wang GL. Glycogen Synthase Kinase-3β Inhibition Prevents Remifentanil-Induced Postoperative Hyperalgesia via Regulating the Expression and Function of AMPA Receptors. Anesth Analg 2014; 119:978-987. [DOI: 10.1213/ane.0000000000000365] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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35
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Al-Metwalli RR. The optimal effect-site concentration of sufentanil for laryngeal mask insertion during induction with target-controlled propofol infusion at 4.0 μg/mL. Saudi J Anaesth 2014; 8:215-9. [PMID: 24843335 PMCID: PMC4024679 DOI: 10.4103/1658-354x.130721] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objective: The objective of this study is to determine the optimal effect-site concentration (Ce) of sufentanil for satisfactory insertion of laryngeal mask airway (LMA) when administered with a target-controlled infusion (TCI) of propofol at 4.0 μg/mL. Materials and Methods: A total of 25 adult patients scheduled for minor elective surgery were enrolled in this study. All patients received induction with a combination of propofol and sufentanil TCI. The TCI of sufentanil was started at a target Ce of 0.1 ng/mL. After equilibrium with the plasma concentration, the TCI of propofol was initiated, targeting a preset Ce of 4.0 μg/mL. After the loss of consciousness, LMA was inserted and assessed by an experienced Anesthesiologist. The Ce of sufentanil for the next patient was guided by modified Dixon's up-and-down method using 0.05 ng/mL as a step size. The Ce of sufentanil required for successful LMA insertion in 50% of adults (EC50) was determined by calculating the midpoint concentration of all independent pairs of patients after at least seven crossover points. Results: The optimal Ce (EC50) of sufentanil for LMA insertion during propofol induction using target Ce of 4 μg/mL was 0.16 ng/mL (95% confidence interval [CI] = 0.12-0.20). There was a significant reduction in propofol induced pain score P = 0.0275 and insignificant hemodynamic changes. Conclusion: Ce of sufentanil required for successful LMA insertion in 50% of patients (EC50) using propofol target Ce of 4.0 μg/mL was 0.16 ng/mL (95% CI = 0.12-0.20) with a significant reduction in the propofol induced pain and hemodynamic stability.
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Affiliation(s)
- Roshdi R Al-Metwalli
- Department of Anesthesiology, University of Dammam, King Fahad Hospital, Al-Khobar, Saudi Arabia
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36
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The effect of sufentanil administration on remifentanil-based anaesthesia during laparoscopic gynaecological surgery: a double-blind randomized controlled trial. ScientificWorldJournal 2014; 2014:701329. [PMID: 24959618 PMCID: PMC4053216 DOI: 10.1155/2014/701329] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 04/15/2014] [Indexed: 11/18/2022] Open
Abstract
This study assessed the effect of sufentanil administered before conclusion of remifentanil-based anaesthesia on postoperative hyperalgesia and haemodynamic stability in patients undergoing laparoscopic gynaecological surgery. The patients were randomly allocated to a sufentanil administration group (S group) or a normal saline administration group (C group). Anaesthesia was induced and maintained with controlled administration of remifentanil at 10 ng · mL(-1) and propofol under bispectral index guidance. Once the surgical specimen was procured, sufentanil or normal saline was administered at 0.15 ng · mL(-1) and maintained until extubation. The haemodynamic status during anaesthetic emergence was evaluated. The pain and postoperative nausea and vomiting (PONV) were assessed for 72 h following postanaesthetic care unit (PACU) discharge. The S group had significantly lower mean systemic arterial blood pressure and heart rate changes between the start of drug administration and extubation. Postoperative pain was significantly lower in the S group until 24 h following PACU discharge. There were no significant differences in PONV incidence and severity 72 h after PACU discharge between the two groups. Sufentanil administration before concluding remifentanil-based anaesthesia improved postoperative hyperalgesia and achieved haemodynamic stability at extubation without delaying recovery or increasing PONV during laparoscopic gynaecological surgery. Clinical trial registration is found at KCT0000785.
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Kim SH, Stoicea N, Soghomonyan S, Bergese SD. Intraoperative use of remifentanil and opioid induced hyperalgesia/acute opioid tolerance: systematic review. Front Pharmacol 2014; 5:108. [PMID: 24847273 PMCID: PMC4021143 DOI: 10.3389/fphar.2014.00108] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 04/23/2014] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The use of opioids has been increasing in operating room and intensive care unit to provide perioperative analgesia as well as stable hemodynamics. However, many authors have suggested that the use of opioids is associated with the expression of acute opioid tolerance (AOT) and opioid-induced hyperalgesia (OIH) in experimental studies and clinical observations in dose and/or time dependent exposure even when used within the clinically accepted doses. Recently, remifentanil has been used for pain management during anesthesia as well as in the intensive care units because of its rapid onset and offset. OBJECTIVES Search of the available literature to assess remifentanil AOT and OIH based on available published data. METHODS We reviewed articles analyzing remifentanil AOT and OIH, and focused our literature search on evidence based information. Experimental and clinical studies were identified using electronic searches of Medline (PubMed, Ovid, Springer, and Elsevier, ClinicalKey). RESULTS Our results showed that the development of remifentanil AOT and OIH is a clinically significant phenomenon requiring further research. DISCUSSIONS AND CONCLUSIONS AOT - defined as an increase in the required opioid dose to maintain adequate analgesia, and OIH - defined as decreased pain threshold after chronic opioid treatment, should be suspected with any unexplained pain report unassociated with the disease progression. The clinical significance of these findings was evaluated taking into account multiple methodological issues including the dose and duration of opioids administration, the different infusion mode, the co-administrated anesthetic drug's effect, method assessing pain sensitivity, and the repetitive and potentially tissue damaging nature of the stimuli used to determine the threshold during opioid infusion. Future studies need to investigate the contribution of remifentanil induced hyperalgesia to chronic pain and the role of pharmacological modulation to reverse this process.
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Affiliation(s)
- Sang Hun Kim
- Department of Anesthesiology and Pain Medicine, School of Medicine, Chosun University Gwangju, South Korea
| | - Nicoleta Stoicea
- Department of Anesthesiology, Ohio State University Wexner Medical Center Columbus, OH, USA
| | - Suren Soghomonyan
- Department of Anesthesiology, Ohio State University Wexner Medical Center Columbus, OH, USA
| | - Sergio D Bergese
- Department of Anesthesiology, Ohio State University Wexner Medical Center Columbus, OH, USA ; Department of Neurological Surgery, Ohio State University Wexner Medical Center Columbus, OH, USA
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Xia WS, Peng YN, Tang LH, Jiang LS, Yu LN, Zhou XL, Zhang FJ, Yan M. Spinal ephrinB/EphB signalling contributed to remifentanil-induced hyperalgesia via NMDA receptor. Eur J Pain 2014; 18:1231-9. [PMID: 24737575 PMCID: PMC4232047 DOI: 10.1002/j.1532-2149.2014.00478.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2014] [Indexed: 11/24/2022]
Abstract
Background One of the major unresolved issues in treating pain is the paradoxical hyperalgesia produced by opiates, and accumulating evidence implicate that EphBs receptors and ephrinBs ligands are involved in mediation of spinal nociceptive information and central sensitization, but the manner in which ephrinB/EphB signalling acts on spinal nociceptive information networks to produce hyperalgesia remains enigmatic. The objective of this research was to investigate the role of ephrinB/EphB signalling in remifentanil-induced hyperalgesia (RIH) and its downstream effector. Methods We characterized the remifentanil-induced pain behaviours by evaluating thermal hyperalgesia and mechanical allodynia in a rat hind paw incisional model. Protein expression of EphB1 receptor and ephrinB1 ligand in spinal dorsal horn cord was determined by Western blotting, and Fos was determined by immunohistochemistry assay, respectively. To figure out the manner in which ephrinB/EphB signalling acts with N-methyl-d-aspartic acid (NMDA) receptor, we used MK-801, an antagonist of NMDA receptor, trying to suppressed the hyperalgesia induced by ephrinB1-Fc, an agonist of ephrinB/EphB. Results Continuing infusion of remifentanil produced a thermal hyperalgesia and mechanical allodynia, which was accompanied with increased protein expression of spinal-level EphB1 receptor, ephrinB1 ligand and Fos; what appeared above was suppressed by pretreatment with EphB1-Fc, an antagonist of ephrinB/EphB or MK-801, and increased pain behaviours induced by intrathecal injection of ephrinB1-Fc, an agonist of ephrinB/EphB, were suppressed by MK-801. Conclusions Our findings indicated that ephrinB/EphB signalling is involved in RIH. EphrinB/EphB signalling might be the upstream of NMDA receptor. What's already known about this topic? What does this study add?
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Affiliation(s)
- W S Xia
- Department of Anesthesiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Lee MH, Chung MH, Han CS, Lee JH, Choi YR, Choi EM, Lim HK, Cha YD. Comparison of effects of intraoperative esmolol and ketamine infusion on acute postoperative pain after remifentanil-based anesthesia in patients undergoing laparoscopic cholecystectomy. Korean J Anesthesiol 2014; 66:222-9. [PMID: 24729845 PMCID: PMC3983419 DOI: 10.4097/kjae.2014.66.3.222] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 06/25/2013] [Accepted: 06/27/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Remifentanil is a short-acting drug with a rapid onset that is useful in general anesthesia. Recently, however, it has been suggested that the use of opioids during surgery may cause opioid-induced hyperalgesia (OIH). Researchers have recently reported that esmolol, an ultra-short-acing β1 receptor antagonist, reduces the postoperative requirement for morphine and provides more effective analgesia than the administration of remifentanil and ketamine. Hence, this study was conducted to determine whether esmolol reduces early postoperative pain in patients who are continuously infused with remifentanil for anesthesia during laparoscopic cholecystectomy. METHODS Sixty patients scheduled to undergo laparoscopic cholecystectomy were randomly divided into three groups. Anesthesia was maintained with sevoflurane and 4 ng/ml (target-controlled infusion) of remifentanil in all patients. Esmolol (0.5 mg/kg) was injected and followed with a continuous dosage of 10 µg/kg/min in the esmolol group (n = 20). Ketamine (0.3 mg/kg) was injected and followed with a continuous dosage of 3 µg/kg/min in the ketamine group (n = 20), while the control group was injected and infused with an equal amount of normal saline. Postoperative pain score (visual analog scale [VAS]) and analgesic requirements were compared for the first 6 hours of the postoperative period. RESULTS The pain score (VAS) and fentanyl requirement for 15 minutes after surgery were lower in the esmolol and ketamine groups compared with the control group (P < 0.05). There were no differences between the esmolol and ketamine groups. CONCLUSIONS Intraoperative esmolol infusion during laparoscopic cholecystectomy reduced opioid requirement and pain score (VAS) during the early postoperative period after remifentanil-based anesthesia.
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Affiliation(s)
- Mi Hyeon Lee
- Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Mi Hwa Chung
- Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Cheol Sig Han
- Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jeong Hyun Lee
- Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Young Ryong Choi
- Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Eun Mi Choi
- Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hyun Kyung Lim
- Department of Anesthesiology and Pain Medicine, Inha University College of Medicine, Incheon, Korea
| | - Young Duk Cha
- Department of Anesthesiology and Pain Medicine, Inha University College of Medicine, Incheon, Korea
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Population Pharmacokinetic Modeling of Hydromorphone in Cardiac Surgery Patients during Postoperative Pain Therapy. Anesthesiology 2014; 120:378-91. [DOI: 10.1097/aln.0b013e3182a76d05] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Abstract
Background:
Hydromorphone is a µ-selective opioid agonist used in postoperative pain therapy. This study aimed to evaluate the pharmacokinetics of hydromorphone in cardiac surgery patients during postoperative analgesia with target-controlled infusion and patient-controlled analgesia.
Methods:
In this study, 50 adult patients were enrolled to receive intravenous hydromorphone during postoperative pain therapy. Arterial plasma samples were collected for measurements of drug concentration. Population pharmacokinetic parameters were estimated using nonlinear mixed-effects modeling. Results were validated and simulations were carried out to evaluate results.
Results:
Data from 49 patients (age range, 40–81 yr) were analyzed. The pharmacokinetics of hydromorphone were best described by a three-compartment model. Age was incorporated as a significant covariate for elimination clearance and central volume of distribution. Scaling all parameters with body weight improved the model significantly. The final estimates of the model parameters for the typical adult patient (67 yr old, weighing 70 kg) undergoing cardiac surgery were as follows: CL1 = 1.01 l/min, V1 = 3.35 l, CL2 = 1.47 l/min, V2 = 13.9 l, CL3 = 1.41 l/min, and V3 = 145 l. The elimination clearance decreased by 43% between the age of 40 and 80 yr, and simulations demonstrated that context-sensitive half-time increased from 26 to 84 min in 40- and 80-yr-old subjects, respectively.
Conclusions:
The final pharmacokinetic model gave a robust representation of hydromorphone pharmacokinetics. Inclusion of age and body weight to the model demonstrated a significant influence of these covariates on hydromorphone pharmacokinetics. The application of this patient-derived population model in individualized pain therapy should improve the dosing of hydromorphone in patients undergoing cardiac surgery.
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Jiang M, Zhang W, Ma Z, Gu X. Antinociception and prevention of hyperalgesia by intrathecal administration of Ro 25-6981, a highly selective antagonist of the 2B subunit of N-methyl-d-aspartate receptor. Pharmacol Biochem Behav 2013; 112:56-63. [DOI: 10.1016/j.pbb.2013.09.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 08/08/2013] [Accepted: 09/18/2013] [Indexed: 11/29/2022]
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Li Y, Wang H, Xie K, Wang C, Yang Z, Yu Y, Wang G. Inhibition of glycogen synthase kinase-3β prevents remifentanil-induced hyperalgesia via regulating the expression and function of spinal N-methyl-D-aspartate receptors in vivo and vitro. PLoS One 2013; 8:e77790. [PMID: 24147079 PMCID: PMC3797695 DOI: 10.1371/journal.pone.0077790] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 09/04/2013] [Indexed: 11/18/2022] Open
Abstract
A large number of experimental and clinical studies have confirmed that brief remifentanil exposure can enhance pain sensitivity presenting as opioid-induced hyperalgesia (OIH). N-methyl-D-aspartate (NMDA) receptor antagonists have been reported to inhibit morphine analgesic tolerance in many studies. Recently, we found that glycogen synthase kinase-3β (GSK-3β) modulated NMDA receptor trafficking in a rat model of remifentanil-induced postoperative hyperalgesia. In the current study, it was demonstrated that GSK-3β inhibition prevented remifentanil-induced hyperalgesia via regulating the expression and function of spinal NMDA receptors in vivo and in vitro. We firstly investigated the effects of TDZD-8, a selective GSK-3β inhibitor, on thermal and mechanical hyperalgesia using a rat model of remifentanil-induced hyperalgesia. GSK-3β activity as well as NMDA receptor subunits (NR1, NR2A and NR2B) expression and trafficking in spinal cord L4-L5 segments were measured by Western blot analysis. Furthermore, the effects of GSK-3β inhibition on NMDA-induced current amplitude and frequency were studied in spinal cord slices by whole-cell patch-clamp recording. We found that remifentanil infusion at 1 μg·kg(-1)·min(-1) and 2 μg·kg(-1)·min(-1) caused mechanical and thermal hyperalgesia, up-regulated NMDA receptor subunits NR1 and NR2B expression in both membrane fraction and total lysate of the spinal cord dorsal horn and increased GSK-3β activity in spinal cord dorsal horn. GSK-3β inhibitor TDZD-8 significantly attenuated remifentanil-induced mechanical and thermal hyperalgesia from 2 h to 48 h after infusion, and this was associated with reversal of up-regulated NR1 and NR2B subunits in both membrane fraction and total lysate. Furthermore, remifentanil incubation increased amplitude and frequency of NMDA receptor-induced current in dorsal horn neurons, which was prevented with the application of TDZD-8. These results suggest that inhibition of GSK-3β can significantly ameliorate remifentanil-induced hyperalgesia via modulating the expression and function of NMDA receptors, which present useful insights into the mechanistic action of GSK-3β inhibitor as potential anti-hyperalgesic agents for treating OIH.
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Affiliation(s)
- Yize Li
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, P. R. China
- Tianjin Research Institute of Anesthesiology, Tianjin, P. R. China
| | - Haiyun Wang
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, P. R. China
- Tianjin Research Institute of Anesthesiology, Tianjin, P. R. China
| | - Keliang Xie
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, P. R. China
- Tianjin Research Institute of Anesthesiology, Tianjin, P. R. China
| | - Chunyan Wang
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, P. R. China
- Tianjin Research Institute of Anesthesiology, Tianjin, P. R. China
| | - Zhuo Yang
- Medical School, Nankai University, Tianjin, P. R. China
| | - Yonghao Yu
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, P. R. China
- Tianjin Research Institute of Anesthesiology, Tianjin, P. R. China
| | - Guolin Wang
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, P. R. China
- Tianjin Research Institute of Anesthesiology, Tianjin, P. R. China
- * E-mail:
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Raffa RB, Pergolizzi JV. Opioid-Induced Hyperalgesia: Is It Clinically Relevant for the Treatment of Pain Patients? Pain Manag Nurs 2013; 14:e67-83. [DOI: 10.1016/j.pmn.2011.04.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 04/12/2011] [Accepted: 04/13/2011] [Indexed: 11/15/2022]
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Chen L, Wang M, Xiang H, Lin X, Cao D, Ye L. Prediction of effect-site concentration of sufentanil by dose-response target controlled infusion of sufentanil and propofol for analgesic and sedation maintenance in burn dressing changes. Burns 2013; 40:455-9. [PMID: 23993735 DOI: 10.1016/j.burns.2013.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Revised: 06/18/2013] [Accepted: 08/04/2013] [Indexed: 10/26/2022]
Abstract
This study was to investigate the feasibility and efficiency of by target-controlled infusion (TCI) for analgesia and sedation during burn dressing change, and to predict the effect-site concentration of sufentanil. Eighty burn patients were randomly and evenly divided into four groups according to target sufentanil effect-site concentration (0.2, 0.3, 0.4 and 0.5 ng/ml). The sufentanil-propofol TCI was carried out during dressing changes. The effect-site concentration of propofol was maintained at 1.2 μg/ml. The dose-response relationships of sufentanil for providing adequate analgesia were evaluated by visual analog scales and Ramsay sedation scores. The effect-site concentration of sufentanil was calculated by Probit regression analysis. Incidence of respiratory depression, doctors and patients' satisfaction and adverse events were assessed. The EC50 and EC95 of sufentanil to maintain anesthesia for uncovering the inner layer dressings during TCI were 0.278 ng/ml (95% CI 0.231-0.318 ng/ml) and 0.394 ng/ml (95% CI 0.366-0.530 ng/ml), respectively, while the EC50 and EC95 of sufentanil to maintain anesthesia for wound management were 0.349 ng/ml (95% CI 0.299-0.366 ng/ml) and 0.465 ng/ml (95% CI 0.430-0.563 ng/ml), respectively. Doctors and patients' satisfaction were significantly higher in the 0.4 and 0.5 ng/ml groups than the 0.2 ng/ml group. One and three patients had respiratory depression in the 0.4 and 0.5 ng/ml groups, respectively. No adverse events occurred after operations. In conclusion, low dose sufentanil-propofol TCI for anesthesia and sedation maintenance in burn dressing changes is feasible and effective, and wound management requires higher effect-site concentrations of sufentanil than disclosing inner layer dressings.
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Affiliation(s)
- Lingyang Chen
- Department of Anesthesiology, Affiliated Taizhou Hospital of Wenzhou Medical College, Linhai, Zhejiang 317000, China
| | - Mingcang Wang
- Department of Anesthesiology, Affiliated Taizhou Hospital of Wenzhou Medical College, Linhai, Zhejiang 317000, China.
| | - Haifei Xiang
- Department of Anesthesiology, Affiliated Taizhou Hospital of Wenzhou Medical College, Linhai, Zhejiang 317000, China
| | - Xianju Lin
- Department of Anesthesiology, Affiliated Taizhou Hospital of Wenzhou Medical College, Linhai, Zhejiang 317000, China
| | - Donghang Cao
- Department of Anesthesiology, Affiliated Taizhou Hospital of Wenzhou Medical College, Linhai, Zhejiang 317000, China
| | - Liyue Ye
- Department of Burn, Affiliated Taizhou Hospital of Wenzhou Medical College, Linhai, Zhejiang 317000, China
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Hu LG, Pan JH, Li J, Kang F, Jiang L. Effects of different doses of sufentanil and remifentanil combined with propofol in target-controlled infusion on stress reaction in elderly patients. Exp Ther Med 2013; 5:807-812. [PMID: 23407772 PMCID: PMC3570228 DOI: 10.3892/etm.2013.900] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 01/10/2013] [Indexed: 02/07/2023] Open
Abstract
The current study aimed to observe the effects of sufentanil and remifentanil combined with propofol in target-controlled infusion (TCI) on perioperative stress reaction in elderly patients. A total of 80 elderly patients requiring general anesthesia were recruited. They were divided into four groups (each n=20) according to different target concentrations of remifentanil and sufentanil. These target concentrations were: 4 ng/ml remifentanil + 0.2 ng/ml sufentanil for group I; 3 ng/ml remifentanil + 0.3 ng/ml sufentanil for group II; 2 ng/ml remifentanil + 0.5 ng/ml sufentanil for anesthesia induction and post-intubation 3 ng/ml remifentanil + 0.2 ng/ml sufentanil for anesthesia maintenance for group III; and 5 ng/ml remifentanil for anesthesia induction and post-intubation 4 ng/ml remifentanil for anesthesia maintenance for group IV. Norepinephrine (NE), epinephrine (E) and angiotensin II (Ang II) levels in plasma were measured prior to the induction of anesthesia, as well as at several different time-points following surgery. The numbers of intraoperative severe hemodynamic fluctuation, postoperative eye-opening and extubation time, and post-extubation restlessness and pain scores were recorded. Group IV had a larger circulation fluctuation control number and higher levels of NE, E and Ang II at 3 h after surgery than any other group (P<0.01). Although group IV had shorter postoperative eye-opening and extubation times compared with the other groups (P<0.05), it also had higher restlessness and pain scores (P<0.01). The combined use of sufentanil and remifentanil stabilizes perioperative hemodynamics and reduces stress hormone levels.
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Affiliation(s)
- Li-Guo Hu
- Department of Anesthesiology, The Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui 230001, P.R. China
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Saari TI, Fechner J, Ihmsen H, Schüttler J, Jeleazcov C. Analysis of total and unbound hydromorphone in human plasma by ultrafiltration and LC–MS/MS: Application to clinical trial in patients undergoing open heart surgery. J Pharm Biomed Anal 2012; 71:63-70. [DOI: 10.1016/j.jpba.2012.07.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 07/17/2012] [Accepted: 07/22/2012] [Indexed: 11/26/2022]
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Saari TI, Fechner J, Ihmsen H, Schüttler J, Jeleazcov C. Determination of total and unbound sufentanil in human plasma by ultrafiltration and LC–MS/MS: Application to clinical pharmacokinetic study. J Pharm Biomed Anal 2012; 66:306-13. [DOI: 10.1016/j.jpba.2012.03.050] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 03/23/2012] [Indexed: 11/16/2022]
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Lee JY, Lim BG, Park HY, Kim NS. Sufentanil infusion before extubation suppresses coughing on emergence without delaying extubation time and reduces postoperative analgesic requirement without increasing nausea and vomiting after desflurane anesthesia. Korean J Anesthesiol 2012; 62:512-7. [PMID: 22778885 PMCID: PMC3384787 DOI: 10.4097/kjae.2012.62.6.512] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 11/04/2011] [Accepted: 11/22/2011] [Indexed: 11/19/2022] Open
Abstract
Background Coughing, hypertension, tachycardia, and even laryngospasm can occur due to airway irritation during emergence from anesthesia. We investigated the effect of maintaining a sufentanil infusion during emergence from anesthesia by evaluating the incidence of cough and recovery profiles at extubation. Methods In total, eighty-four patients undergoing an elective laparoscopic hysterectomy were randomly divided into two sufentanil groups and a control group. During emergence, sufentanil was administered in the sufentanil groups at a rate of 0.2 µg/kg/hr (Group S1) or 0.3 µg/kg/hr (Group S2), and saline was administered to the control group. Cough score, hemodynamic changes, and recovery profiles, such as duration from skin closure to a bispectral index of 80, to eye opening at verbal command, to tracheal extubation and the total duration of study solution infusion, were recorded. The pain score, the total volume of administered patient-controlled analgesia (PCA), and the postoperative nausea and vomiting (PONV) score were evaluated 1, 6, and 24 hours after surgery. Results Groups S1 and S2 showed significantly lower cough scores and smaller hemodynamic changes on extubation compared to Group C. Recovery profiles showed no significant differences among the three groups. Pain score, PONV at 1 hour postoperatively, and the total volume of PCA administered at all evaluation times were significantly lower in Groups S1 and S2 than in the control group. However, pain score, and PONV at 6 hours and 24 hours postoperatively showed no significant differences. Conclusions A sufentanil infusion (0.2-0.3 µg/kg/hr) during emergence from desflurane anesthesia may suppress coughing on extubation in patients with body mass indexes (BMI) of 21-26 without delaying extubation time. It may also reduce the postoperative analgesic requirement without increasing PONV.
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Affiliation(s)
- Jea Yeun Lee
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Seoul, Korea
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Dieterich M, Müller-Jordan K, Stubert J, Kundt G, Wagner K, Gerber B. Pain management after cesarean: a randomized controlled trial of oxycodone versus intravenous piritramide. Arch Gynecol Obstet 2012; 286:859-65. [PMID: 22622852 DOI: 10.1007/s00404-012-2384-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 05/08/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE Primary objective was to assess whether oral analgesia with oxycodone offers superior pain relief after cesareans than patient controlled analgesia (PCA). Secondary outcomes were additional pain medication, time to first mobilization, therapeutic side effects, postoperative restrictions, overall satisfaction and costs. MATERIALS AND METHODS Randomized controlled trial at a University Hospital conduct between July 2009 and November 2009. Of the 1,112 patients, 257 met the inclusion criteria and 239 agreed to participate. Patients were randomly assigned to either receive intravenous piritramide PCA (2 mg piritramide/ml 0.9 % saline) or oral oxycodone (20 mg). Pain was assessed on a visual analog pain scale (VAS) at 2, 12, 24, 32, 40, 48 and 72 h after cesarean. RESULTS No differences in VAS scores were observed within the general study population. Pain scores of oxycodone versus PCA were comparable at 24 h. Patients randomized to PCA demonstrated increased demand for rescue medication 48 h after cesarean (p = 0.057). In the PCA group, patients with previous cesarean had increased operative times, a trend towards increased VAS scores after 48 h (p = 0.081) and increased VAS scores in comparison to patients who did not have cesarean before (p = 0.044). For this subgroup, no difference was seen in the oxycodone patients (p = 0.883). CONCLUSION General satisfaction with both treatment regimes was high. The results support the potential use of oral pain regimes and emphasis the importance of a multimodal approach to treat post-cesarean pain. Oral oxycodone is a not expensive, convenient and comparable analgesic to PCA devices with opioids after cesarean. Trial registration at clinicaltrials.gov identifier: NCT 01115101.
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Affiliation(s)
- Max Dieterich
- Department of Obstetrics and Gynecology, University of Rostock, Südring 81, 18059 Rostock, Germany.
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Hong BH, Lee WY, Kim YH, Yoon SH, Lee WH. Effects of intraoperative low dose ketamine on remifentanil-induced hyperalgesia in gynecologic surgery with sevoflurane anesthesia. Korean J Anesthesiol 2011; 61:238-43. [PMID: 22025947 PMCID: PMC3198186 DOI: 10.4097/kjae.2011.61.3.238] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 03/10/2011] [Accepted: 03/11/2011] [Indexed: 12/03/2022] Open
Abstract
Background Remifentanil is useful during general anesthesia because of its rapid onset and short acting time. However, some studies report that due to opioid-induced hyperalgesia (OIH) and tolerance, remifentanil also increases early postoperative pain. The occurrence of OIH and opioid-induced tolerance is mainly thought to be due to central sensitization by the activation of NMDA receptors. Therefore, we investigated the effects of continuous infusion of ketamine, an NMDA receptor antagonist, on postoperative pain and the quantity of opioids used. Methods 40 patients scheduled to undergo laparoscopic gynecologic surgery were randomly allocated into two groups. Anesthesia was equally maintained with sevoflurane and 4 ng/ml of remifentanil in all patients. Ketamine (0.3 mg/kg) was injected and followed with a continuous dosage of 3 µl/kg/min in the ketamine group (n = 20) while the control group was injected and infused with an equal amount of normal saline. We compared postoperative VAS up to 7 hours and morphine demand through PCA. Results Postoperative VAS and morphine demand was significantly lower in the ketamine group 2 and 3 hours after surgery, respectively. Conclusions When general anesthesia is maintained with sevoflurane and remifentanil in patients undergoing laparoscopic gynecologic surgery, continuous infusion of low dose ketamine decreased early postoperative pain and the quantity of opioids used.
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Affiliation(s)
- Boo Hwi Hong
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Deajeon, Korea
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