https://orcid.org/0000-0003-1882-9020
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Abstract
Background
Remifentanil-induced hyperalgesia (RIH) increases the risk of persistent postoperative pain, making early postoperative analgesic therapy ineffective and affecting postoperative patient satisfaction. This study aimed to verify the effects of gradual withdrawal of remifentanil combined with postoperative pump infusion of remifentanil on postoperative hyperalgesia and pain in patients undergoing laparoscopic hysterectomy.
Methods
This trial was a factorial design, double-blind, randomized controlled trial. Patients undergoing laparoscopic hysterectomy were randomly allocated to the control group, postoperative pump infusion of remifentanil group, gradual withdrawal of remifentanil group, or gradual withdrawal plus postoperative pump infusion of remifentanil group (n = 35 each). The primary outcome was postoperative mechanical pain thresholds in the medial forearm. The secondary outcomes included postoperative mechanical pain thresholds around the incision, pain numeric rating scale scores, analgesic utilization, awakening agitation or sedation scores, a 15-item quality of recovery survey, and postoperative complications.
Results
Gradual withdrawal of remifentanil significantly increased postoperative pain thresholds versus abrupt discontinuation (P < 0.05), whereas postoperative infusion did not show significant differences compared to the absence of infusion (P > 0.05). The combined gradual withdrawal and postoperative infusion group exhibited the highest thresholds and had the lowest postoperative pain scores and analgesic requirements as well as the highest quality of recovery scores (P < 0.05). No significant differences were observed for agitation scores, sedation scores, or complication rates (P > 0.05).
Conclusion
The novel combined gradual withdrawal and postoperative infusion of remifentanil uniquely attenuates postoperative hyperalgesia, pain severity, analgesic necessity, and improves recovery quality after laparoscopic hysterectomy.
Abbreviations
RIH, remifentanil-induced hyperalgesia; OIH, Opioid-induced hyperalgesia; NSAIDs, non-steroidal anti-inflammatory drugs; PACU, postanesthesia care unit; NRS, numeric rating scale; HR, heart rate; BP, blood pressure; PETCO2, partial pressure of end-tidal carbon dioxide; BIS, bispectral index; SAS, Sedation -Agitation Scale; QoR-15, 15-item quality of recovery; ERAS, Enhanced recovery after surgery; LTP, long-term potentiation; BMI, body mass index; ASA, American Society of Anesthesiologist.
Data Sharing Statement
Please contact the corresponding author if you would like access to the datasets used or analyzed in this research.
Ethics Approval and Informed Consent
This trial was approved by the Ethics Committee of the Affiliated Hospital of Xuzhou Medical University (no. XYFY2023-KL049-02). The trial was registered before patient enrollment with the Chinese Clinical Trial Registry (ChiCTR2300074524). Written informed consent was obtained from all patients. This is in accordance with the Declaration of Helsinki.
Acknowledgments
The authors thank the Affiliated Hospital of Xuzhou Medical University for support with this study.
Author Contributions
All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
Disclosure
The work described has not been submitted elsewhere for publication, in whole or in part, and all the authors listed have approved the enclosed manuscript. The authors report no conflicts of interest in this work.