Interaction between postoperative shivering and hyperalgesia caused by high-dose remifentanil / 대한마취과학회지
Korean Journal of Anesthesiology
;
: 44-51, 2014.
Article
in English
| WPRIM
| ID: wpr-52960
ABSTRACT
BACKGROUND:
High-dose remifentanil-based anesthesia is associated with opioid-induced hyperalgesia (OIH) and postanesthetic shivering (PAS). These effects can be prevented by N-methyl-d-aspartate (NMDA) receptor antagonists. This study aimed to investigate correlations between OIH and PAS caused by high-dose remifentanil and the effects of low-dose ketamine on OIH and PAS.METHODS:
Seventy-five patients scheduled for single-port laparoscopic gynecologic surgery were randomly allocated into three groups, each of which received intraoperative remifentanil group L at 0.1 microg/kg/min; group H at 0.3 microg/kg/min; and group HK at 0.3 microg/kg/min plus 0.25 mg/kg ketamine just before incision, followed by a continuous infusion of 5 microg/kg/min ketamine until skin closure.RESULTS:
PAS, postoperative tactile pain threshold, and the extent of hyperalgesia in group H were significantly different (P < 0.05) than in the other two groups. PAS was significantly correlated with OIH, including mechanically evoked pain such as postoperative tactile pain threshold (r = -0.529, P = 0.01) (r = -0.458, P = 0.021) and the extent of hyperalgesia (r = 0.537, P = 0.002) (r = 0.384, P = 0.031), respectively, in group H and group HK. Notably, both groups were treated with high-dose remifentanil. Tympanic membrane temperature, time to first postoperative analgesic requirement, postoperative pain scores, analgesic consumption, and cumulative patient-controlled analgesia volume containing morphine were comparable in all three groups.CONCLUSIONS:
OIH, including the enhanced perception of pain, and PAS were both associated with high-dose remifentanil, were significantly correlated and were attenuated by a low dose of ketamine. This suggests that a common mechanism in part mediated through activation of the central glutamatergic system (e.g., NMDA receptors), underlies the two effects caused by high doses of remifentanil.
Full text:
Available
Index:
WPRIM (Western Pacific)
Main subject:
Pain, Postoperative
/
Shivering
/
Skin
/
Gynecologic Surgical Procedures
/
Tympanic Membrane
/
Analgesia, Patient-Controlled
/
N-Methylaspartate
/
Pain Threshold
/
Hyperalgesia
/
Anesthesia
Limits:
Female
/
Humans
Language:
English
Journal:
Korean Journal of Anesthesiology
Year:
2014
Type:
Article
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