Chang-Hoon Koo1, Youn Joung Cho1, Deok Man Hong1, Yunseok Jeon1, Tae Kyong Kim2. 1. Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea. 2. Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea. Electronic address: ktkktk@gmail.com.
Abstract
STUDY OBJECTIVE: High-dose remifentanil during surgery paradoxically increases postoperative pain intensity and morphine consumption. Cyclooxygenase inhibitors decrease prostaglandin synthesis, thereby antagonizing N-methyl-d-aspartate receptor activation, and may reduce hyperalgesia. This study was performed to evaluate whether postoperative morphine consumption increased following intraoperative continuous remifentanil infusion and whether this could be prevented by intravenous ibuprofen pretreatment. DESIGN: A randomized controlled study. SETTING:Single university hospital, study period from September 2014 to March 2015. PATIENTS: One hundred and twenty patients undergoing pancreaticoduodenectomy. INTERVENTIONS: After induction of anesthesia, patients received remifentanil target-controlled infusion (effect site concentration of 4 ng/mL or 1 ng/mL) with or without intravenous ibuprofen (800 mg). MEASUREMENTS: Postoperative cumulative total morphine consumption and pain intensity were assessed. MAIN RESULTS:Intraoperative remifentanil use in patients receiving high-doseremifentanil was more than 3-fold higher than that in patients receiving low-dose remifentanil (2666.8± 858.4 vs 872.0 ± 233.3 μg, respectively; P< .001). However, cumulative total morphine consumption at postoperative 1, 3, 6, 12, 24, and 48 hours did not differ among the groups. There were no differences among the groups in the self-administered analgesic dose by the patients using a controlled analgesia device, number of self-administration attempts, numerical rating scale for pain, or analgesic side effects. CONCLUSIONS: We found no influence on postoperative pain after high-dose remifentanil in patients undergoing pancreaticoduodenectomy. Addition of intravenous ibuprofen did not reduce postoperative morphine consumption or pain intensity.
RCT Entities:
STUDY OBJECTIVE: High-dose remifentanil during surgery paradoxically increases postoperative pain intensity and morphine consumption. Cyclooxygenase inhibitors decrease prostaglandin synthesis, thereby antagonizing N-methyl-d-aspartate receptor activation, and may reduce hyperalgesia. This study was performed to evaluate whether postoperative morphine consumption increased following intraoperative continuous remifentanil infusion and whether this could be prevented by intravenous ibuprofen pretreatment. DESIGN: A randomized controlled study. SETTING: Single university hospital, study period from September 2014 to March 2015. PATIENTS: One hundred and twenty patients undergoing pancreaticoduodenectomy. INTERVENTIONS: After induction of anesthesia, patients received remifentanil target-controlled infusion (effect site concentration of 4 ng/mL or 1 ng/mL) with or without intravenous ibuprofen (800 mg). MEASUREMENTS: Postoperative cumulative total morphine consumption and pain intensity were assessed. MAIN RESULTS: Intraoperative remifentanil use in patients receiving high-dose remifentanil was more than 3-fold higher than that in patients receiving low-dose remifentanil (2666.8 ± 858.4 vs 872.0 ± 233.3 μg, respectively; P< .001). However, cumulative total morphine consumption at postoperative 1, 3, 6, 12, 24, and 48 hours did not differ among the groups. There were no differences among the groups in the self-administered analgesic dose by the patients using a controlled analgesia device, number of self-administration attempts, numerical rating scale for pain, or analgesic side effects. CONCLUSIONS: We found no influence on postoperative pain after high-dose remifentanil in patients undergoing pancreaticoduodenectomy. Addition of intravenous ibuprofen did not reduce postoperative morphine consumption or pain intensity.