Abstract
BackgroundIn adults, high-dose remifentanil during surgery has been reported to increase postoperative opioid consumption, but this has not been well documented in children. Multimodal analgesia is recommended in the perioperative period for adolescent idiopathic scoliosis (AIS), but no report has examined opioid consumption under epidural analgesia, which is one of the most common types of analgesia.AimsTo investigate the association between intraoperative remifentanil dosage and postoperative opioid consumption in AIS in the setting of combined epidural analgesia for postoperative multimodal analgesia.MethodsIn this retrospective cohort study, patients aged 10-18 years who underwent surgery for scoliosis and epidural analgesia for postoperative pain between July 2012 and April 2019 were included. The primary endpoint was the association between intraoperative cumulative weight-adjusted remifentanil dosage and logarithmic transformation of cumulative weight-adjusted fentanyl consumption in the intensive care unit (ICU). Nonopioid analgesics were investigated as secondary endpoints. An epidural catheter was inserted by the surgeon intraoperatively, and a local anesthetic was administered at the end of the surgery. Multivariate linear regression analysis with adjustment for confounders was performed for all analyses.ResultsIn total, 142 patients were included, and the median intraoperative remifentanil dosage for all patients was 0.27 (interquartile range, 0.24-0.34) µg/kg/min. No association was observed between cumulative weight-adjusted intraoperative dosage of remifentanil and fentanyl, even after adjusting for potential confounders (slope = −1.25; 95% confidence interval [CI], −4.35 to 1.85; P = 0.43). No association was observed between nonopioid analgesic use and intraoperative remifentanil dosage.ConclusionNo association was noted between remifentanil dosage during surgery for AIS and postoperative opioid consumption with epidural analgesia. However, this study has limitations due to its retrospective design; thus, further prospective studies are warranted.
Highlights
Surgery for adolescent idiopathic scoliosis (AIS) is challenging for anesthesiologists
Calvin et al reported no correlation between remifentanil dosage and postoperative opioid consumption during surgery for AIS [12]; this may not be a definitive conclusion owing to the small sample size and racial differences in their study [13]
The exclusion criteria were as follows: (i) patients who used inhalational anesthetics, even for a short period, intraoperatively; (ii) patients who were not monitored for Motor-evoked potentials (MEPs); (iii) patients who were not admitted to the intensive care unit (ICU) postoperatively; (iv) patients who had not received remifentanil intraoperatively; (v) patients who had a previous diagnosis of opioid dependence or alcohol abuse; (vi) patients who had received opioids for preoperative chronic pain; and (vii) patients who could not communicate because of psychiatric disorders or intubation upon ICU admission
Summary
High-dose remifentanil during surgery has been reported to increase postoperative opioid consumption, but this has not been well documented in children. Multimodal analgesia is recommended in the perioperative period for adolescent idiopathic scoliosis (AIS), but no report has examined opioid consumption under epidural analgesia, which is one of the most common types of analgesia
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