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High-dose intraoperative remifentanil infusion increases early postoperative analgesic consumption: a prospective, randomized, double-blind controlled study

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Abstract

Purpose

The purpose of this study was to determine whether intraoperative infusion of remifentanil induces acute tolerance to opioids, and compare the postoperative pain and opioid consumption by the effect site concentrations of remifentanil.

Methods

One hundred and ninety-eight patients undergoing gastrectomy were randomly assigned to maintain target effect site concentrations of remifentanil at 0 (Group 1, n = 39), 2 (Group 2, n = 40), 4 (Group 3, n = 39), 8 (Group 4, n = 40), or 12 ng/ml (Group 5, n = 40) during operation. Postoperative pain intensities and fentanyl requirement were recorded at postoperative 2, 6, 24, and 48 h.

Results

Fentanyl requirement for postoperative 2 h was significantly greater in Group 5 compared to Group 1 (376 ± 116 vs. 283 ± 129 µg, P = 0.03). However, there were no differences in fentanyl requirements among the groups after postoperative 2 h. Also, total fentanyl consumption for 48 h was similar in all groups (Group 1; 3106 ± 629, Group 2; 2970 ± 705, Group 3; 3017 ± 555, Group 4; 3151 ± 606, and Group 5; 2984 ± 443 µg, P = 0.717). Pain scores at rest and during deep breathing were comparable in all groups at the time of each examination.

Conclusion

Intraoperative infusion of remifentanil with 12 ng/ml of effect site concentration in patients undergoing gastrectomy increases early postoperative fentanyl requirement. Acute opioid tolerance would be developed by higher concentration of remifentanil than dosage of common anesthetic practice.

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Acknowledgements

The authors are grateful to all colleagues in helping to perform this study

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Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Chonbuk National University Hospital, Geonji-ro 20, Jeonju, 54907, Republic of Korea

    Deokkyu Kim, Hyung-Sun Lim, Myung-Jong Kim, WooJoo Jeong & Seonghoon Ko

  2. Research Institute of Clinical Medicine-Biomedical Research Institute, Chonbuk National University Medical School, Jeonju, Republic of Korea

    Hyung-Sun Lim & Seonghoon Ko

Authors
  1. Deokkyu Kim
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  2. Hyung-Sun Lim
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  3. Myung-Jong Kim
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  4. WooJoo Jeong
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Correspondence to Seonghoon Ko.

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All authors have no interest declared.

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Kim, D., Lim, HS., Kim, MJ. et al. High-dose intraoperative remifentanil infusion increases early postoperative analgesic consumption: a prospective, randomized, double-blind controlled study. J Anesth 32, 886–892 (2018). https://doi.org/10.1007/s00540-018-2569-6

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  • DOI: https://doi.org/10.1007/s00540-018-2569-6

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