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Intraoperative naloxone reduces remifentanil-induced postoperative hyperalgesia but not pain: a randomized controlled trial.
- Source :
-
BJA: The British Journal of Anaesthesia . Dec2017, Vol. 119 Issue 6, p1161-1168. 8p. 1 Diagram, 2 Charts, 3 Graphs. - Publication Year :
- 2017
-
Abstract
- <bold>Background: </bold>Intraoperative use of a high-dose remifentanil may induce postoperative hyperalgesia. Low-dose naloxone can selectively reverse some adverse effects of opioids without compromising analgesia. We thus hypothesized that the intraoperative use of a high-dose remifentanil combined with a low-dose naloxone infusion reduces postoperative hyperalgesia compared with the use of remifentanil alone.<bold>Methods: </bold>Patients undergoing elective thyroid surgery were randomly assigned into one of three groups, depending on the intraoperative effect-site concentration of remifentanil, with or without a continuous infusion of naloxone: 4 ng ml-1 remifentanil with 0.05 μg kg-1 h-1 naloxone in the high-remifentanil with naloxone group, and 4 or 1 ng ml-1 remifentanil with a placebo in the high- or low-remifentanil groups, respectively. We measured the pain thresholds (primary outcome) to mechanical stimuli using von Frey filaments and incidence of hyperalgesia on the peri-incisional area 24 h after surgery. We also measured pain intensity, analgesic consumptions and adverse events up to 48 h after surgery.<bold>Results: </bold>The pain threshold presented as von Frey numbers [median (interquartile range)] was significantly lower in the high-remifentanil group (n=31) than in the high-remifentanil with naloxone (n=30) and the low-remifentanil (n=30) groups [3.63 (3.22-3.84) vs 3.84 (3.76-4.00) vs 3.80 (3.69-4.08), P=0.011]. The incidence of hyperalgesia was also higher in the high-remifentanil group than in the other groups [21/31 vs 10/30 vs 9/30, P=0.005]. Postoperative pain intensity, analgesic consumptions and adverse events were similar between groups.<bold>Conclusions: </bold>The intraoperative use of low-dose naloxone combined with high-dose remifentanil reduced postoperative hyperalgesia but not pain.<bold>Clinical trial registration: </bold>NCT02856087. [ABSTRACT FROM AUTHOR]
- Subjects :
- *REMIFENTANIL
*DRUG overdose
*NALOXONE
*ANALGESIA
*OPIOIDS
*PHYSIOLOGY
*NARCOTIC antagonists
*ANALGESICS
*COMPARATIVE studies
*HYPERALGESIA
*LONGITUDINAL method
*RESEARCH methodology
*INTRAOPERATIVE care
*MEDICAL cooperation
*NARCOTICS
*POSTOPERATIVE pain
*RESEARCH
*STATISTICAL sampling
*EVALUATION research
*PAIN measurement
*RANDOMIZED controlled trials
*BLIND experiment
*THERAPEUTICS
POSTOPERATIVE pain prevention
Subjects
Details
- Language :
- English
- ISSN :
- 00070912
- Volume :
- 119
- Issue :
- 6
- Database :
- Academic Search Index
- Journal :
- BJA: The British Journal of Anaesthesia
- Publication Type :
- Academic Journal
- Accession number :
- 126300363
- Full Text :
- https://doi.org/10.1093/bja/aex253