Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Sep;61(3):238-43.
doi: 10.4097/kjae.2011.61.3.238. Epub 2011 Sep 23.

Effects of intraoperative low dose ketamine on remifentanil-induced hyperalgesia in gynecologic surgery with sevoflurane anesthesia

Boo Hwi Hong  1 , Wang Yong Lee, Yoon Hee Kim, Seok Hwa Yoon, Won Hyung Lee
Affiliations

Effects of intraoperative low dose ketamine on remifentanil-induced hyperalgesia in gynecologic surgery with sevoflurane anesthesia

Boo Hwi Hong et al. Korean J Anesthesiol. 2011 Sep.

Abstract

Background: Remifentanil is useful during general anesthesia because of its rapid onset and short acting time. However, some studies report that due to opioid-induced hyperalgesia (OIH) and tolerance, remifentanil also increases early postoperative pain. The occurrence of OIH and opioid-induced tolerance is mainly thought to be due to central sensitization by the activation of NMDA receptors. Therefore, we investigated the effects of continuous infusion of ketamine, an NMDA receptor antagonist, on postoperative pain and the quantity of opioids used.

Methods: 40 patients scheduled to undergo laparoscopic gynecologic surgery were randomly allocated into two groups. Anesthesia was equally maintained with sevoflurane and 4 ng/ml of remifentanil in all patients. Ketamine (0.3 mg/kg) was injected and followed with a continuous dosage of 3 µl/kg/min in the ketamine group (n = 20) while the control group was injected and infused with an equal amount of normal saline. We compared postoperative VAS up to 7 hours and morphine demand through PCA.

Results: Postoperative VAS and morphine demand was significantly lower in the ketamine group 2 and 3 hours after surgery, respectively.

Conclusions: When general anesthesia is maintained with sevoflurane and remifentanil in patients undergoing laparoscopic gynecologic surgery, continuous infusion of low dose ketamine decreased early postoperative pain and the quantity of opioids used.

Keywords: Hyperalgesia; Ketamine; Postoperative pain; Remifentanil; Sevoflurane.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Postoperative pain up to 7 hours after operation. Data are mean ± SD. Group C (control): infused and injected with 0.9 % normal saline. Group K (ketamine): infused with ketamine at 3 µg/kg/min after a 0.3 mg/kg loading dose of ketamine. Each time point in group K had a lower VAS score compared to group C (*P < 0.05).
Fig. 2
Fig. 2
Postoperative pain up to 7 hours after operation. Data are mean ± SD. Group C(control): infused and injected with 0.9% normal saline. Group K (ketamine): infused with ketamine at 3 µg/kg/min after a 0.3 mg/kg loading dose of ketamine. Each time point in group K had a lower VAS score compared to group C (*P < 0.05).
See this image and copyright information in PMC

References

    1. Thompson JP, Rowbotham DJ. Remifentanil--an opioid for the 21st century. Br J Anaesth. 1996;76:341–343. - PubMed
    1. Guignard B, Bossard AE, Coste C, Sessler DI, Lebrault C, Alfonsi P, et al. Acute opioid tolerance: intraoperative remifentanil increases postoperative pain and morphine requirement. Anesthesiology. 2000;93:409–417. - PubMed
    1. Vinik HR, Kissin I. Rapid development of tolerance to analgesia during remifentanil infusion in humans. Anesth Analg. 1998;86:1307–1311. - PubMed
    1. Angst MS, Koppert W, Pahl I, Clark DJ, Schmelz M. Short-term infusion of the mu-opioid agonist remifentanil in humans causes hyperalgesia during withdrawal. Pain. 2003;106:49–57. - PubMed
    1. Derrode N, Lebrun F, Levron JC, Chauvin M, Debaene B. Influence of peroperative opioid on postoperative pain after major abdominal surgery: sufentanil TCI versus remifentanil TCI. A randomized, controlled study. Br J Anaesth. 2003;91:842–849. - PubMed

LinkOut - more resources