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Intra‐operative remifentanil might influence pain levels in the immediate post‐operative period after major abdominal surgery
Author(s) -
Hansen E. G.,
Duedahl T. H.,
Rømsing J.,
Hilsted K.L.,
Dahl J. B.
Publication year - 2005
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.2005.00861.x
Subject(s) - medicine , remifentanil , anesthesia , surgery , period (music) , abdominal surgery , propofol , physics , acoustics
Background: Remifentanil, a widely used analgesic agent in anaesthesia, has a rapid onset and short duration of action. In clinical settings, this requires an appropriate pain strategy to prevent unacceptable pain in the post‐operative period. The aim of this study was to investigate whether remifentanil had any impact on post‐operative pain and opioid consumption after major abdominal surgery. Methods: Fifty patients undergoing major abdominal surgery were randomized to receive either remifentanil 0.4 µg/kg/min or placebo intra‐operatively, in addition to basic combined general and epidural anaesthesia, in this double‐blind study. Patients received patient‐controlled analgesia with morphine for 24 h post‐operatively. Morphine consumption, assessment of pain at rest and during coughing, side‐effects and levels of sensory block were recorded during the first 24 h post‐operatively. Results: Twenty‐one patients receiving remifentanil and 18 patients receiving placebo completed the study. The median visual analogue scale (VAS) score at rest from 0 to 2 h was significantly increased in the remifentanil group [40 mm (27–61 mm)] vs. placebo [13 mm (3–35 mm)] ( P < 0.05). No significant differences in morphine consumption, VAS score during coughing or adverse effects were observed between the groups. Conclusion: The results are weak and difficult to interpret. They could indicate that a high dose of remifentanil added to otherwise sufficient combined general and epidural anaesthesia may induce opioid‐induced hyperalgesia and/or clinically acute opioid tolerance after major abdominal surgery; however, as no significant differences could be observed between the groups after 2 h post‐operatively, the clinical relevance of these observations is questionable.