Acute opioid tolerance - Intraoperative remifentanil increases postoperative pain and morphine requirement
Acute opioid tolerance - Intraoperative remifentanil increases postoperative pain and morphine requirement
复制标题
DOI：
10.1097/00000542-200008000-00019
复制
发表时间：
2000-08-01
期刊：
影响因子：
8.8
通讯作者：
Chauvin, M
中科院分区：
文献类型：
--
作者：
Guignard, B;Bossard, AE;Chauvin, M
背景：急性阿片类药物耐受的快速发展在动物中得到了很好的证实，并且更有可能发生在大剂量的短效药物中。因此，作者验证了术中应用瑞芬太尼会导致急性阿片耐受的假设，其表现为术后疼痛和阿片类药物需求增加。方法：50例腹部大手术患者随机分为两种麻醉方案：(1)地氟醚维持在0.5最低肺泡浓度，并根据自主神经反应滴定瑞芬太尼(瑞芬太尼组)；或(2)瑞芬太尼0.1mg。Kg(-1)。Min(-1)和地氟醚滴定至自主神经反应(地氟醚组)。所有患者在手术结束前40min静脉注射吗啡0.15 mg/kg。吗啡最初由麻醉后护理护士根据需要进行滴定，对分组分配视而不见。结果：瑞芬太尼平均输注率为0.3+/-0.2 mg。Kg(-1)。瑞芬太尼组的Min(-1)明显大于地氟醚组。各组术中血流动力学反应相似。瑞芬太尼组术后疼痛评分显著高于对照组。这些患者需要吗啡的时间明显早于地氟醚组，在术后前24小时内需要的吗啡几乎是后者的两倍：59 mg(25-75%四分位数范围，43-71)对32 mg(25-75%四分位数范围，19-59；P<；0.01)。结论：相对大剂量的瑞芬太尼增加了术后疼痛和吗啡用量。这些数据表明，瑞芬太尼会导致急性阿片耐受和痛觉过敏。
Background: Rapid development of acute opioid tolerance Is well established in animals and is more likely to occur with large doses of short-acting drugs. The authors therefore tested the hypothesis that intraoperative remifentanil administration results in acute opioid tolerance that is manifested by increased postoperative pain and opioid requirement.Methods: Fifty adult patients undergoing major abdominal surgery were randomly assigned to two anesthetic regimens: (1) desflurane was kept constant at 0.5 minimum alveolar concentrations and a remifentanil Infusion was titrated to autonomic responses (remifentanil group); or (2) remifentanil at 0.1 mu g . kg(-1) . min(-1) and desflurane titrated to autonomic responses (desflurane group). All patients were given a bolus of 0.15 mg/kg morphine 40 min before the end of surgery. Morphine was initially titrated to need by postanesthesia care nurses blinded to group assignment. Subsequently, patients who were also blinded to group assignment-controlled their own morphine administration, Pain scores and morphine consumption were recorded for 24 postoperative h.Results: The mean remifentanil infusion rate was 0.3 +/- 0.2 mu g . kg(-1) . min(-1) in the remifentanil group, which was significantly greater than in the desflurane group. Intraoperative hemodynamic responses mere similar in each group. Postoperative pain scores were significantly greater in the remifentanil group. These patients required morphine significantly earlier than those in the desflurane group and needed nearly twice as much morphine in the first 24 postoperative h: 59 mg (25-75% Interquartile range, 43-71) versus 32 mg (25-75% interquartile range, 19-59; P < 0.01).Conclusion: Relatively large-dose intraoperative remifentanil increased postoperative pain and morphine consumption. These data suggest that remifentanil causes acute opioid tolerance and hyperalgesia.