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
Randomized Controlled Trial
. 2015 Apr 8:15:46.
doi: 10.1186/s12871-015-0026-8.

Stepwise tapering of remifentanil at the end of surgery decreased postoperative pain and the need of rescue analgesics after thyroidectomy

Sun Sook Han  1 , Sang Hwan Do  2   3 , Tae Hee Kim  4 , Won Joon Choi  5 , Ji Sup Yun  6 , Jung Hee Ryu  7   8
Affiliations
Randomized Controlled Trial

Stepwise tapering of remifentanil at the end of surgery decreased postoperative pain and the need of rescue analgesics after thyroidectomy

Sun Sook Han et al. BMC Anesthesiol. .

Abstract

Background: This study was designed to investigate whether stepwise tapering of remifentanil at the end of surgery could decrease postoperative pain scores and requirements of rescue analgesics after remifentanil-desflurane anesthesia in patients with thyroidectomy.

Methods: Sixty two patients undergoing thyroidectomy under general anesthesia were randomly allocated into two groups. All patients were anesthetised with desflurane and high-dose remifentanil. Remifentnail was infused at the rate of 0.3 μg/kg/min until the end of surgery in patients of the control group (group A) whereas remifentanil was tapered gradually from 0.3 to 0.1 μg/kg/min until the end of surgery for at least 30 minutes in patients with group B. Pain scores (0-100 numerical rating scale, NRS), rescue analgesic requirements and adverse events were assessed at 30 min, 2 h, 6 h, 12 h, and 24 h after operation.

Results: There was a significant decrease in pain scores at 30 min (20 [0-80] vs. 50 [0-100], P = 0.002) and 2 h (30 [10-60] vs. 40 [20-80], P = 0.018) after surgery in group B compared with group A. In addition, rescue analgesics are less required in group B than in group A postoperatively (2 [1-3] vs. 3 [2,3], P = 0.039). There were no significant differences in adverse events between the two groups.

Conclusions: Tapering of remifentanil at the end of surgery decreased postoperative pain scores immediately after thyroidectomy with desflurane and high-dose remifentanil anesthesia.

Trial registration: Clinical Research information Service (CRiS, registration number KCT0000589).

PubMed Disclaimer

Figures

Figure 1
Figure 1
Consort flow diagram. Seventy three patients were assessed for eligibility and 11 patients were excluded because of exclusion criteria (9 patients) and patient refusals (2 patients). Sixty two patients were randomized for the study and 57 patients were included in the final analysis. Five patients (4 patients from group A and 1 patient from group B) were excluded during the study period for protocol violations, intraoperative hypotension, re-operation and the use of NSAID on the day of operation.
Figure 2
Figure 2
End-tidal concentration of desflurane during the operation. Values are given as mean (SD). A group: no tapering group, B group: tapering group.
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(3):341–343. doi: 10.1093/bja/76.3.341. - DOI - 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(2):409–417. doi: 10.1097/00000542-200008000-00019. - DOI - PubMed
    1. Joly V, Richebe P, Guignard B, Fletcher D, Maurette P, Sessler DI, et al. Remifentanil-induced postoperative hyperalgesia and its prevention with small-dose ketamine. Anesthesiology. 2005;103(1):147–155. doi: 10.1097/00000542-200507000-00022. - DOI - 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(1–2):49–57. doi: 10.1016/S0304-3959(03)00276-8. - DOI - 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(6):842–849. doi: 10.1093/bja/aeg263. - DOI - PubMed

Publication types

MeSH terms

Associated data

LinkOut - more resources