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Interaction between postoperative shivering and hyperalgesia caused by high-dose remifentanil.

Song YK, Lee C, Seo DH, Park SN, Moon SY, Park CH - Korean J Anesthesiol (2014)

Bottom Line: These effects can be prevented by N-methyl-d-aspartate (NMDA) receptor antagonists.OIH, including the enhanced perception of pain, and PAS were both associated with high-dose remifentanil, were significantly correlated and were attenuated by a low dose of ketamine.This suggests that a common mechanism in part mediated through activation of the central glutamatergic system (e.g., NMDA receptors), underlies the two effects caused by high doses of remifentanil.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, Wonkwang University College of Medicine, Iksan, Korea.

ABSTRACT

Background: High-dose remifentanil-based anesthesia is associated with opioid-induced hyperalgesia (OIH) and postanesthetic shivering (PAS). These effects can be prevented by N-methyl-d-aspartate (NMDA) receptor antagonists. This study aimed to investigate correlations between OIH and PAS caused by high-dose remifentanil and the effects of low-dose ketamine on OIH and PAS.

Methods: Seventy-five patients scheduled for single-port laparoscopic gynecologic surgery were randomly allocated into three groups, each of which received intraoperative remifentanil: group L at 0.1 µg/kg/min; group H at 0.3 µg/kg/min; and group HK at 0.3 µg/kg/min plus 0.25 mg/kg ketamine just before incision, followed by a continuous infusion of 5 µg/kg/min ketamine until skin closure.

Results: PAS, postoperative tactile pain threshold, and the extent of hyperalgesia in group H were significantly different (P < 0.05) than in the other two groups. PAS was significantly correlated with OIH, including mechanically evoked pain such as postoperative tactile pain threshold (r = -0.529, P = 0.01) (r = -0.458, P = 0.021) and the extent of hyperalgesia (r = 0.537, P = 0.002) (r = 0.384, P = 0.031), respectively, in group H and group HK. Notably, both groups were treated with high-dose remifentanil. Tympanic membrane temperature, time to first postoperative analgesic requirement, postoperative pain scores, analgesic consumption, and cumulative patient-controlled analgesia volume containing morphine were comparable in all three groups.

Conclusions: OIH, including the enhanced perception of pain, and PAS were both associated with high-dose remifentanil, were significantly correlated and were attenuated by a low dose of ketamine. This suggests that a common mechanism in part mediated through activation of the central glutamatergic system (e.g., NMDA receptors), underlies the two effects caused by high doses of remifentanil.

No MeSH data available.


Related in: MedlinePlus

Schematic representation depicting mapping of the peri-incisional area for assessment of punctuate mechanical hyperalgesia.
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Figure 1: Schematic representation depicting mapping of the peri-incisional area for assessment of punctuate mechanical hyperalgesia.

Mentions: Stimulation with a Von Frey filament (number, 6.1; force, 100 g) was started outside the hyperalgesia area where no pain sensation was experienced, and was then moved toward the incision until the patient reported a distinct change in perception. The area of hyperalgesia for punctuate mechanical stimulation around the surgical incision was determined by testing along linear paths, quadrilaterally at a distance of 5 cm around the incision, 24 h after surgery. These observations were then translated to graph paper for the calculation of surface area (Fig. 1). The first point where a painful, sore, or sharper feeling was perceived was marked. If no change in sensation occurred, the stimulation was stopped 1 cm from the incision.


Interaction between postoperative shivering and hyperalgesia caused by high-dose remifentanil.

Song YK, Lee C, Seo DH, Park SN, Moon SY, Park CH - Korean J Anesthesiol (2014)

Schematic representation depicting mapping of the peri-incisional area for assessment of punctuate mechanical hyperalgesia.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3927001&req=5

Figure 1: Schematic representation depicting mapping of the peri-incisional area for assessment of punctuate mechanical hyperalgesia.
Mentions: Stimulation with a Von Frey filament (number, 6.1; force, 100 g) was started outside the hyperalgesia area where no pain sensation was experienced, and was then moved toward the incision until the patient reported a distinct change in perception. The area of hyperalgesia for punctuate mechanical stimulation around the surgical incision was determined by testing along linear paths, quadrilaterally at a distance of 5 cm around the incision, 24 h after surgery. These observations were then translated to graph paper for the calculation of surface area (Fig. 1). The first point where a painful, sore, or sharper feeling was perceived was marked. If no change in sensation occurred, the stimulation was stopped 1 cm from the incision.

Bottom Line: These effects can be prevented by N-methyl-d-aspartate (NMDA) receptor antagonists.OIH, including the enhanced perception of pain, and PAS were both associated with high-dose remifentanil, were significantly correlated and were attenuated by a low dose of ketamine.This suggests that a common mechanism in part mediated through activation of the central glutamatergic system (e.g., NMDA receptors), underlies the two effects caused by high doses of remifentanil.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, Wonkwang University College of Medicine, Iksan, Korea.

ABSTRACT

Background: High-dose remifentanil-based anesthesia is associated with opioid-induced hyperalgesia (OIH) and postanesthetic shivering (PAS). These effects can be prevented by N-methyl-d-aspartate (NMDA) receptor antagonists. This study aimed to investigate correlations between OIH and PAS caused by high-dose remifentanil and the effects of low-dose ketamine on OIH and PAS.

Methods: Seventy-five patients scheduled for single-port laparoscopic gynecologic surgery were randomly allocated into three groups, each of which received intraoperative remifentanil: group L at 0.1 µg/kg/min; group H at 0.3 µg/kg/min; and group HK at 0.3 µg/kg/min plus 0.25 mg/kg ketamine just before incision, followed by a continuous infusion of 5 µg/kg/min ketamine until skin closure.

Results: PAS, postoperative tactile pain threshold, and the extent of hyperalgesia in group H were significantly different (P < 0.05) than in the other two groups. PAS was significantly correlated with OIH, including mechanically evoked pain such as postoperative tactile pain threshold (r = -0.529, P = 0.01) (r = -0.458, P = 0.021) and the extent of hyperalgesia (r = 0.537, P = 0.002) (r = 0.384, P = 0.031), respectively, in group H and group HK. Notably, both groups were treated with high-dose remifentanil. Tympanic membrane temperature, time to first postoperative analgesic requirement, postoperative pain scores, analgesic consumption, and cumulative patient-controlled analgesia volume containing morphine were comparable in all three groups.

Conclusions: OIH, including the enhanced perception of pain, and PAS were both associated with high-dose remifentanil, were significantly correlated and were attenuated by a low dose of ketamine. This suggests that a common mechanism in part mediated through activation of the central glutamatergic system (e.g., NMDA receptors), underlies the two effects caused by high doses of remifentanil.

No MeSH data available.


Related in: MedlinePlus