Intraoperative naloxone reduces remifentanil-induced postoperative hyperalgesia but not pain: a randomized controlled trial

Intraoperative use of a high-dose remifentanil may induce postoperative hyperalgesia. Low-dose naloxone can selectively reverse some adverse effects of opioids without compromising analgesia. We thus hypothesized that the intraoperative use of a high-dose remifentanil combined with a low-dose naloxo...

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Published in:British journal of anaesthesia : BJA 2017-12, Vol.119 (6), p.1161-1168
Main Authors: Koo, C.-H., Yoon, S., Kim, B.-R., Cho, Y.J., Kim, T.K., Jeon, Y., Seo, J.-H.
Format: Article
Language:English
Subjects:
Adult
Aged
Analgesics, Opioid - adverse effects
Double-Blind Method
Female
Humans
hyperalgesia
Hyperalgesia - chemically induced
Hyperalgesia - prevention & control
Intraoperative Care - methods
Male
Middle Aged
naloxone
Naloxone - therapeutic use
Narcotic Antagonists - therapeutic use
Pain Measurement
Pain, Postoperative - chemically induced
Pain, Postoperative - prevention & control
Prospective Studies
remifentanil
Remifentanil - adverse effects
Young Adult
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Summary:Intraoperative use of a high-dose remifentanil may induce postoperative hyperalgesia. Low-dose naloxone can selectively reverse some adverse effects of opioids without compromising analgesia. We thus hypothesized that the intraoperative use of a high-dose remifentanil combined with a low-dose naloxone infusion reduces postoperative hyperalgesia compared with the use of remifentanil alone. Patients undergoing elective thyroid surgery were randomly assigned into one of three groups, depending on the intraoperative effect-site concentration of remifentanil, with or without a continuous infusion of naloxone: 4 ng ml−1 remifentanil with 0.05 μg kg−1 h−1 naloxone in the high-remifentanil with naloxone group, and 4 or 1 ng ml−1 remifentanil with a placebo in the high- or low-remifentanil groups, respectively. We measured the pain thresholds (primary outcome) to mechanical stimuli using von Frey filaments and incidence of hyperalgesia on the peri-incisional area 24 h after surgery. We also measured pain intensity, analgesic consumptions and adverse events up to 48 h after surgery. The pain threshold presented as von Frey numbers [median (interquartile range)] was significantly lower in the high-remifentanil group (n=31) than in the high-remifentanil with naloxone (n=30) and the low-remifentanil (n=30) groups [3.63 (3.22–3.84) vs 3.84 (3.76–4.00) vs 3.80 (3.69–4.08), P=0.011]. The incidence of hyperalgesia was also higher in the high-remifentanil group than in the other groups [21/31 vs 10/30 vs 9/30, P=0.005]. Postoperative pain intensity, analgesic consumptions and adverse events were similar between groups. The intraoperative use of low-dose naloxone combined with high-dose remifentanil reduced postoperative hyperalgesia but not pain. NCT02856087.
ISSN:0007-0912
1471-6771
DOI:10.1093/bja/aex253