Remifentanil-induced postoperative hyperalgesia and its prevention with small-dose ketamine
Remifentanil-induced postoperative hyperalgesia and its prevention with small-dose ketamine
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DOI：
10.1097/00000542-200507000-00022
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发表时间：
2005-07-01
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：
Joly, V;Richebe, P;Chauvin, M
背景资料：瑞芬太尼诱导的继发性痛觉过敏在动物和健康志愿者中均有实验记录，但从未在临床上有过。这项研究测试了增加疼痛敏感性评估围切口异常性疼痛和痛觉过敏后，相对大剂量的术中remifentanil和小剂量氯胺酮防止这种hyperalgesia.Methods：75例接受腹部大手术的患者被随机分配接受（1）术中remifentanil在0.05 μ g（.）kg（-1）（.）min（-1）（小剂量瑞芬太尼）;（2）术中瑞芬太尼0.40 μ g（.）kg（-1）（.）min（-1）（大剂量瑞芬太尼）;或（3）术中瑞芬太尼0.40 μ g（.）kg（-1）（.）min（-1）和0.5 mg/kg氯胺酮，然后术中输注5 μ g（.）kg（-1）（.）min（-1）直至皮肤闭合，然后2 μ g（.）kg（-1）（.）min（-1）持续48 h（大剂量瑞芬太尼-氯胺酮）。记录术后48小时的疼痛评分和吗啡用量。在24和48 h进行定量感觉测试，呼气峰流速测量和认知测试。结果：与其他两组相比，大剂量瑞芬太尼组对手术伤口附近von Frey毛发刺激的痛觉过敏和吗啡需求量较大（P < 0.05），对von Frey毛发刺激的异常性疼痛较大（P < 0.01），这是可比的。有没有显着差异，疼痛，压力疼痛检测阈值与algometer，峰值流量，认知测试，或副作用。结论：一个相对较大剂量的术中瑞芬太尼触发术后继发性痛觉过敏。小剂量氯胺酮可预防瑞芬太尼诱导的痛觉过敏，这与N-甲基-D-天冬氨酸疼痛促进过程有关。
Background: Remifentanil-induced secondary hyperalgesia has been documented experimentally in both animals and healthy human volunteers, but never clinically. This study tested the hypotheses that increased pain sensitivity assessed by periincisional allodynia and hyperalgesia can occur after relatively large-dose intraoperative remifentanil and that small-dose ketamine prevents this hyperalgesia.Methods: Seventy-five patients undergoing major abdominal surgery were randomly assigned to receive (1) intraoperative remifentanil at 0.05 mu g (.) kg(-1) (.) min(-1) (small-dose remifentail); (2) intraoperative remifentanil at 0.40 mu g (.) kg(-1) (.) min(-1) (large-dose rentifentanif); or (3) intraoperative remifentanil at 0.40 mu g (.) kg(-1) (.) min(-1) and 0.5 mg/kg ketamine just after the induction, followed by an intraoperative infusion of 5 mu g (.) kg(-1) (.) min(-1) until skin closure and then 2 mu g (.) kg(-1) (.) min(-1) for 48 h (large-dose remifentanil-ketamine). Pain scores and morphine consumption were recorded for 48 postoperative hours. Quantitative sensory tests, peak expiratory flow measures, and cognitive tests were performed at 24 and 48 h.Results: Hyperalgesia to von Frey hair stimulation adjacent to the surgical wound and morphine requirements were larger (P < 0.05) and allodynia to von Frey hair stimulation was greater (P < 0.01) in the large-dose remifentanil group compared with the other two groups, which were comparable. There were no significant differences in pain, pressure pain detection threshold with an algometer, peak flow, cognitive tests, or side effects.Conclusion: A relatively large dose of intraoperative remifentanil triggers postoperative secondary hyperalgesia. Remifentanil-induced hyperalgesia was prevented by small-dose ketamine, implicating an N-methyl-D-aspartate pain-facilitator process.