Postoperative Drip-Infusion of Remifentanil Reduces Postoperative Pain—A Retrospective Observative Study

Yi-Hsuan Huang,Nian-Cih Huang,Kuang-I Cheng,Bo-Feng Lin,Jing Kao,Hou-Chuan Lai,Zhi-Fu Wu,Meei-Shyuan Lee,Yao-Tsung Lin

doi:10.3390/ijerph18179225

Abstract

Development of remifentanil-induced hyperalgesia (RIH) postoperatively is an unpleasant experience that requires further treatment. This study assessed the effects of gradual withdrawal combined with drip infusion of remifentanil on postoperative pain and the requirement for rescue analgesics. A total of 559 patients receiving total intravenous anesthesia with propofol and remifentanil were enrolled. All patients either underwent gradual withdrawal of remifentanil (GWR) or gradual withdrawal combined with drip infusion (GWDR) with a dose of 1 mcg·kg−1 for 30 min after extubation. The numeric rating scale (NRS) and the requirement of rescue analgesics were assessed. The requirement for rescue analgesics was significantly lower in the GWDR group than in the GWR group (13.2% vs. 35.7%; p < 0.001). At the post-anesthetic care unit (PACU), patients in the GWDR group had a lower NRS pain score (p < 0.001). In addition, in the postoperative 2nd hour, patients in the GWDR group had a significantly lower NRS than the GWR group (beta, −0.31; p = 0.003). No remifentanil-related adverse effects were observed. We found that gradual withdrawal combined with drip infusion of remifentanil required less rescue analgesics and reduced pain scores. The new way of remifentanil administration may be effective to prevent RIH.

Highlights

Opioids are a major component of analgesia in the clinical practice of anesthesia.Among them, the application of ultra-short-acting opioids, remifentanil, with its unique chemical structure and high lipid affinity, offers the potent and rapid-onset properties and plays a key role in total intravenous anesthesia (TIVA) [1]
The incidence of postoperative rescue analgesic requirement was lower in the gradual withdrawal combined with drip infusion (GWDR) group than in the gradual withdrawal of remifentanil (GWR) group (13.2% vs. 35.7%; p < 0.001)
Patients in the GWDR group had a significantly lower risk of experiencing mild pain (1–3/10) than the GWR group (OR, 0.30; 95% confidence intervals (CIs), 0.17–0.55; p < 0.001)

Summary

Introduction

Opioids are a major component of analgesia in the clinical practice of anesthesia. The application of ultra-short-acting opioids, remifentanil, with its unique chemical structure and high lipid affinity, offers the potent and rapid-onset properties and plays a key role in total intravenous anesthesia (TIVA) [1]. The combination of remifentanil and propofol by target-controlled infusion (TCI) was the so-called “ideal”. TIVA [2] to accomplish adequate analgesia, depth of anesthesia, and rapid postoperative recovery. The intraoperative use of short-acting opioids is associated with opioid-induced hyperalgesia (OIH) after surgery [3]. Once early prevention of OIH is established perioperatively, delayed recovery/discharge and further development of chronic pain can be avoided. The concern of OIH has risen in the perioperative period, remifentanil, a short-acting opioid [4]

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