Advertisement

Canadian Journal of Anesthesia

, Volume 55, Issue 12, pp 813–818 | Cite as

Pre-treatment with morphine does not prevent the development of remifentanil-induced hyperalgesia

  • Conor McDonnell
  • Christian Zaarour
  • Rebecca Hull
  • Priya Thalayasingam
  • Carolyne Pehora
  • Janet Ahier
  • Mark W. Crawford
Reports Of Original Investigations

Abstract

Purpose: Remifentanil, an ultra short-acting opioid commonly used to supplement general anesthesia, is associated with the development of hyperalgesia that manifests clinically as an increase in postoperative analgesic requirement. This study involving adolescents undergoing scoliosis surgery evaluated whether pre-treatment with morphine prior to commencing remifentanil infusion would decrease the initial 24-hr morphine consumption and pain scores.

Methods: Forty ASA 1–11 pediatric patients undergoing surgical correction of idiopathic scoliosis were recruited in a prospective, randomized, double-blind fashion to receive 150µg·kg−1 morphine or an equal volume saline prior to commencing remifentanil by infusion. The primary outcome was the initial 24-hr postoperative morphine consumption. Numeric rating scale (NRS) pain scores at rest and on coughing were recorded, as were scores for nausea, vomiting, and sedation and incidences of pruritus.

Results: The groups were demographically similar. No differences were observed between groups vis-à-vis the initial 24-hr morphine consumption, NRS pain scores, sedation, nausea, or vomiting.

Conclusion: Pre-treatment with 150µg·kg−1 morphine did not decrease the initial 24-hr morphine consumption in adolescents who received remifentanil by infusion for surgical correction of idiopathic scoliosis.

Keywords

Morphine Remifentanil Numeric Rating Scale Idiopathic Scoliosis Hydromorphone 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Un prétraitement à la morphine n’empêche pas l’apparition d’hyperalgésie provoquée par le rémifentanil

Résumé

Objectif: Le rémifentanil est un opioïde à action extra-courte couramment utilisé comme adjuvant à une anesthésie générate. II est associé à l’apparition d’hyperalgéesie, laquelle prend la forme clinique d’une augmentation des besoins analgésiques postopératoires. Cette étude portait sur des adolescents subissant une chirurgie de correction de scoliose. Son objectif était de déterminer si un prétraitement à la morphine avant la perfusion de rémifentanil diminuerait la consommation de morphine et l’intensite de la douleur dans les 24 premières heures suivant l’opération.

Méthode: Quarante adolescents ASA 1–11 subissant une chirurgie corrective pour une scoliose idiopathique ont été recrutés de façon prospective, randomisée et à double insu, à recevoir de la morphine 150 µg·kg−1 ou un volume équivalent de sérum physiologique avant le début d’une perfusion de rémifentanil. La consommation de morphine durant les 24 premières heures postopératoires était l’objectif primaire. Les scores de douleur sur l’échelle d’évaluation numérique (EEN) au repos et en toussant ont été notes, de même que les scores concernant les nausées, les vomissements, la sédation et l’aptparition de prurit.

Résultats: Les groupes étaient semblables d’un point de vue démographique. Aucune différence n’a été observée entre les groupes quant à la consommation de morphine des 24 premières heures, les scores de douleur EEN, la sédation, les nausées ou les vomissements.

Conclusion: Le prétraitement avec 150µ·kg−1 de morphine n’a pas diminué la consommation de morphine durant les 24 premières heures postopératoires chez des adolescents recevant une perfusion de rémifentanil pour une chirurgie corrective d’une scoliose idiopathique.

References

  1. 1.
    Gibson PR. Anaesthesia for correction of scoliosis in children. Anaesth Intensive Care 2004; 32: 548–59.PubMedGoogle Scholar
  2. 2.
    Thompson JP, Rowbotham DJ. Remifentanil — an opioid for the 21st century. Br J Anaesth 1996; 76: 341–3.PubMedGoogle Scholar
  3. 3.
    Crawford MW, Hickey C, Zaarour C, Howard A, Naser B. Development of acute opioid tolerance during infusion of remifentanil for pediatric scoliosis surgery. Anesth Analg 2006; 102: 1662–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Guignard B, Bossard AE, Coste C, et al. Acute opioid tolerance: intraoperative remifentanil increases postoperative pain and morphine requirement. Anesthesiology 2000; 93: 409–17.PubMedCrossRefGoogle Scholar
  5. 5.
    Joly V, Richebe P, Guignard, B, et al. Remifentanil-induced postoperative hyperalgesia and its prevention with small-dose ketamine. Anesthesiology 2005; 103: 147–55.PubMedCrossRefGoogle Scholar
  6. 6.
    Van Elstraete AC, Lebrun T, Sandefo I, Polin B. Ketamine does not decrease postoperative pain after remifentanil-based anaesthesia for tonsillectomy in adults. Acta Anaesthesiol Scand 2004; 48: 756–60.PubMedCrossRefGoogle Scholar
  7. 7.
    Ganne O, Abisseror M, Menault P, et al. Low-dose ketamine failed to spare morphine after a remifentanil-based anaesthesia for ear, nose and throat surgery. Eur J Anaesthesiol 2005; 22: 426–30.PubMedCrossRefGoogle Scholar
  8. 8.
    Engelhardt T, Zaarour C, Naser B, DeRuiter J, Crawford MW. Effects of intraoperative ketamine on remifentanil-induced opioid tolerance after scoliosis surgery. Anesthesiology 2006; 105: A592 (abstract).Google Scholar
  9. 9.
    Batra TK, Shamsah M, Al-Khasti MJ, Rawdhan HJ, Al-Qattan AR, Belani KG. Intraoperative small-dose ketamine does not reduce pain or analgesic consumption during perioperative opioid analgesia in children after tonsillectomy. Int J Clin Pharmacol Ther 2007; 45: 155–60.PubMedGoogle Scholar
  10. 10.
    Lenz H, Raeder J, Hoymork SC. Administration of fentanyl before remifentanil-based anaesthesia has no influence on post-operative pain or analgesic consumption. Acta Anaesthesiol Scand 2008; 52: 149–54.PubMedGoogle Scholar
  11. 11.
    Koppert W. Opioid induced hyperalgesia — Pathophysiology and clinical relevance. Acute Pain 2007; 9: 21–34.CrossRefGoogle Scholar
  12. 12.
    Dunbar PJ, Chapman CR, Buckley P, Gavrin JR. Clinical analgesic equivalence for morphine and hydromorphone with prolonged PCA. Pain 1196; 68: 265–70.CrossRefGoogle Scholar

Copyright information

© Canadian Anesthesiologists 2008

Authors and Affiliations

  • Conor McDonnell
    • 2
  • Christian Zaarour
    • 2
  • Rebecca Hull
    • 2
  • Priya Thalayasingam
    • 2
  • Carolyne Pehora
    • 2
  • Janet Ahier
    • 1
  • Mark W. Crawford
    • 2
  1. 1.the Division of Orthopedic SurgeryThe Hospital For Sick Children, University of TorontoOntarioCanada
  2. 2.Department of AnesthesiaThe Hospital for Sick Children, University of TorontoTorontoCanada

Personalised recommendations