Abstract
BackgroundMismanagement of remifentanil leads to severe side effects such as opioid-induced tolerance and hyperalgesia. Recently studies revealed an alternative withdrawal method to limit these side effects. A gradual withdrawal of remifentanil seems to be associated with less pain. The hypothesis of this double-blinded, randomized controlled trial was that a gradual withdrawal of remifentanil would be associated with less immediate post-operative pain compared to after an abrupt discontinuation of remifentanil in patients who underwent thyroid surgery.MethodsThis double-blinded, randomized controlled trial was conducted in a tertiary level hospital in Brussels (Belgium) from April until August 2017. 34 patients undergoing thyroid surgery were randomized and 29 patients completed the study. After randomization, patients undergoing thyroid surgery were allocated to two groups: one with an abrupt discontinuation of remifentanil after surgery and one with a gradual withdrawal of remifentanil after surgery. The primary outcome was the initial post-operative demand of analgesic medication.ResultsGradual withdrawal of remifentanil was associated with a delayed initial post-operative demand of analgesic medication (P = 0.006). The first morphine bolus was given after 76.3 +/− 89.0 min in the group with a gradual withdrawal of remifentanil versus after 9.0 +/− 13.5 min in the group with an abrupt discontinuation of remifentanil.However, overall morphine consumption, numeric rating scale scores, Ramsay Sedation Scale scores, and quality of recovery scores (QoR-40) were similar in both groups (P > 0.05).ConclusionThough overall morphine consumption, numeric rating scale scores, Ramsay Sedation Scale scores, and quality of recovery scores (QoR-40) are not altered, a gradual withdrawal of remifentanil after thyroid surgery is safe and associated with a delayed initial post-operative demand of analgesic drugs. The withdrawal process does, however, require vigilance and training.Trial registrationClinicaltrials.gov NCT03110653 (PI: Luc Barvais; date of registration: 03/31/2017).
Highlights
Mismanagement of remifentanil leads to severe side effects such as opioid-induced tolerance and hyperalgesia
The mismanagement of remifentanil can lead to a wide range of side effects including opioid-induced tolerance and hyperalgesia
Our group wanted to put this theory into practice within the perioperative period. The hypothesis of this double-blinded, randomized controlled trial was that a gradual withdrawal of remifentanil would be associated with less immediate post-operative pain compared to after an abrupt discontinuation of remifentanil in patients undergoing thyroid surgery
Summary
Mismanagement of remifentanil leads to severe side effects such as opioid-induced tolerance and hyperalgesia. Remifentanil has been subjected to bad press [1, 2] This drug was hailed for its benefits which included being an ultra short-acting phenylpiperidine opioid analgesic with high lipid solubility, having a rapid onset of action, and being rapidly metabolized by non-specific blood and tissue esterases. For these reasons, many anesthesiologists became accustomed to using remifentanil. The mismanagement of remifentanil can lead to a wide range of side effects including opioid-induced tolerance and hyperalgesia. Due to its rapid elimination, a bridge to post-operative analgesia is a necessity when administering this drug
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
