Impact of intraoperative remifentanil on postoperative pain and opioid use in thyroid surgery.

Autor: Wu JX; Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York., Assel M; Department of Epidemiology & Statistics, Memorial Sloan Kettering Cancer Center, New York, New York., Vickers A; Department of Epidemiology & Statistics, Memorial Sloan Kettering Cancer Center, New York, New York., Afonso AM; Department of Anesthesiology & Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York., Twersky RS; Department of Anesthesiology & Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York., Simon BA; Department of Anesthesiology & Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.; Josie Robertson Surgery Center, Memorial Sloan Kettering Cancer Center, New York, New York., Cohen MA; Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York., Rieth EF; Department of Anesthesiology & Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York., Cracchiolo JR; Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
Jazyk: angličtina
Zdroj: Journal of surgical oncology [J Surg Oncol] 2019 Dec; Vol. 120 (8), pp. 1456-1461. Date of Electronic Publication: 2019 Nov 03.
DOI: 10.1002/jso.25746
Abstrakt: Background and Objectives: Remifentanil infusion is used as an intraoperative anesthetic for thyroidectomy, but has been associated with acute opioid tolerance and hyperalgesia. A national shortage of remifentanil provided an opportunity to study postoperative pain in patients undergoing thyroidectomy.
Methods: Retrospective review of prospectively collected data from an outpatient surgery center. Primary analysis compared patients treated before and after remifentanil shortage.
Results: Median postoperative opioid consumption was 20 morphine milligram equivalents (MMEs) among those treated in the high-dose period and 15 MMEs in the low-dose period. Remifentanil/weight received was a significant predictor of requiring a postoperative narcotic (P = .006). Total non-remifentanil narcotics administered were equivalent but patients in the low dose period received higher amounts of intraoperative long-acting narcotics.
Conclusions: Remifentanil infusion for thyroid surgery is associated with higher postoperative pain and postoperative narcotics requirement. While a hyperalgesia state is possible, shifting of longer-acting narcotics from intraoperative to postoperatively is also supported.
(© 2019 Wiley Periodicals, Inc.)
Databáze: MEDLINE
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