The Effects of Intraoperative Adenosine Infusion on Acute Opioid Tolerance and Opioid Induced Hyperalgesia Induced by Remifentanil in Adult Patients Undergoing Tonsillectomy
The Effects of Intraoperative Adenosine Infusion on Acute Opioid Tolerance and Opioid Induced Hyperalgesia Induced by Remifentanil in Adult Patients Undergoing Tonsillectomy
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DOI：
10.3344/kjp.2011.24.1.7
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发表时间：
2011-03-01
影响因子：
2.8
通讯作者：
Ha, Soo Mi
中科院分区：
文献类型：
--
作者：
Lee, Cheol;Song, Yoon Kwang;Ha, Soo Mi
背景：腺苷已被证明在各种临床情况下具有广泛的独特镇痛作用。本研究的目的是探讨术中输注腺苷对急性阿片耐受和阿片类药物诱导的痛觉过敏的影响remifentanil.Methods：在这项研究中，90例患者被随机分为两组，接受腺苷（腺苷组）或生理盐水（remifentnail组）静脉瑞芬太尼为基础的麻醉和生理盐水（七氟醚组）七氟醚麻醉。腺苷组患者在麻醉诱导10分钟后接受80 μ g/kg/min剂量的腺苷，瑞芬太尼组和七氟醚组患者在麻醉诱导10分钟后接受等体积的生理盐水，直至手术结束。结果：腺苷组术中瑞芬太尼时间加权平均用量显著低于瑞芬太尼组（P = 0.00），腺苷组术后1、6、12、24 h疼痛程度、术后首次镇痛时间、术后24 h镇痛剂量显著低于瑞芬太尼组（P = 0.00）。瑞芬太尼组术后首次镇痛时间早于七氟醚组和腺苷组（P = 0.00）。七氟醚组和腺苷组24 h哌替啶用量明显低于瑞芬太尼组（P = 0.00）。术后12 h七氟醚组和腺苷组疼痛视觉模拟评分均显著低于瑞芬太尼组（P = 0.00）。腺苷组低血压发生率（P = 0.024）和麻黄碱用量（P = 0.011）均显著高于七氟醚组。结论：腺苷可预防瑞芬太尼所致的阿片耐受和阿片致痛过敏。
Background:Adenosine has been shown to have a wide spectrum of unique pain-relieving effects in various clinical situations. The aim of this study was to investigate the effects of intraoperative adenosine infusion on acute opioid tolerance and opioid induced hyperalgesia induced by remifentanil in adult patients undergoing tonsillectomy.Methods:For this study, ninety patients were randomly allocated into groups that receive either adenosine (adenosine group) or saline (remifentnail group) intravenously under remifentanil based anesthesia and saline (sevoflurane group) under sevoflurane anesthesia. The patients in adenosine group received adenosine at dose of 80 mu g/kg/min, and those in remifentnail group and sevoflurane group received an equal volume of saline 10 minutes after the induction of anesthesia until the end of surgery. Intraoperative evaluation included time weighted mean remifentanil dose, and postoperative evaluations included degree of pain severity at 1, 6, 12, and 24 hours, time to first postoperative requirement, and analgesic dose required during 24 hours after operation.Results:Time weighted mean remifentanil dose during intraoperative period in adenosine group was significantly lower than that of remifentnail group (P = 0.00). The first postoperative analgesic were required earlier in remifentanil group than sevoflurane group or adenosine group (P = 0.00). Pethidine requirement during 24 hours in sevoflurane group and adenosine group was significantly lower than that of remifentnail group (P = 0.00). The visual analog scale scores for pain in sevoflurane group and adenosine group were significantly lower than those of remifentnail group for 12 hours after operation (P = 0.00). Incidence of hypotension (P = 0.024) and number of ephedrine administered (P = 0.011) in adenosine group were significantly higher than those of sevoflurane group.Conclusions:The above results suggest that intraoperative adenosine infusion prevent acute opioid tolerance and opioid induced hyperalgesia induced by remifentanil.