Effect of intraoperative infusion of ketamine on remifentanil-induced hyperalgesia

Abstract

BackgroundOpioid induced hyperalgesia (OIH) is related with high opioid dosage, a long duration of opioid administration, and abrupt discontinuation of infused opioids in anesthetic settings. Ketamine is known to attenuate OIH efficiently, but methods of administration and methods to quantify and assess a decrease in OIH vary. We demonstrated the existence of remifentanil-induced hyperalgesia and investigated the ability of ketamine to attenuate OIH.MethodsSeventy-five patients undergoing laparoscopic gynecologic surgery under remifentanil-based anesthesia were assigned to one of the following groups: (1) group RL (remifentanil 0.05 µg/kg/min), (2) group RH (remifentanil 0.3 µg/kg/min), or (3) group KRH (remifentanil 0.3 µg/kg/min + ketamine 0.5 mg/kg bolus with 5 µg/kg/min infusion intraoperatively). Desflurane was administered for maintenance of anesthesia to target bispectral index scores (40-60) and hemodynamic parameters (heart rate and blood pressure < ± 20% of baseline values). All parameters related to OIH and its attenuation induced by ketamine were investigated.ResultsThere was no significant difference among the three groups related to demographic and anesthetic parameters except the end-tidal concentration of desflurane. Additional analgesic consumption, numerical rating scale scores at 6 and 24 h, and cumulative fentanyl dose were significantly higher in group RH than in the other two groups. The value difference of the Touch-Test sensory evaluation was significantly higher negative in group RH than in the other two groups.ConclusionsRemifentanil-induced hyperalgesia is significantly attenuated by intraoperative bolus and infusion of ketamine. Ketamine also decreased tactile sensitization, as measured by Touch-Test sensory evaluation.

Low‐ versus high‐dose intraoperative opioids: A systematic review with meta‐analyses and trial sequential analyses

“…35 All trials administered opioids before surgical incision. The administered dose ratio between lowand high-dose groups were respectively 1:15 in one trial, 27 between 1:8 and 1:6 in five trials, 29,34,37,41,52 between 1:5 and 1:2 in 18 trials 26,28,[31][32][33]35,36,[38][39][40]42,43,[46][47][48][49][50][51] and at a ratio of 1:1.5 in three trials. 30,44,45 Of note, one trial administered dose that are beyond what is commonly used in the clinical practice.…”

“…35 No trials injected long-acting opioids such as morphine or hydromorphone at the end of surgery. Over 60% (18 of 27) of the included trials used a volatile-based anaesthesia maintenance, [26][27][28][29][33][34][35][37][38][39][40][41][42]44,46,48,50 while the remaining trials administered propofol. [30][31][32]36,43,45,47,49,51,52 Regarding the types of surgery, authors included patients scheduled for gynaecological surgery in seven trials, [27][28][29][30]35,42,44 for abdominal surgery in nine trials, 33,34,[37][38][39]41,43,49,50 for cardiac surgery in four trials, 31,32,45,51 and finally, we combined the remaining seven tr...…”

“…According to anaesthesia maintenance Volatile anaesthetic 16 Agata et al, 26 Cho et al, 28 Choi et al, 29 Guignard et al, 33 Katz et al, 35 Kim et al, 37 Kong et al, 38 Koo et al, 39 Koo et al, 40 Lee (1) et al, 41 Lee (2) et al, 42 Lee et al, 44 Schmidt et al, 46 Shin et al, 47 Song et al, 48 Treskatsch Fechner et al, 31 Florkiewicz et al, 32 Kim et al, 36 Shin et al, 47 Yildirim et al, 51 Zhang Cho et al, 28 Choi et al, 29 Katz et al, 35 Lee (2)…”

“…Agata et al, 26 Cho et al, 28 Choi et al, 29 Florkiewicz et al, 32 Guignard et al, 33 Kim et al, 36 Kim et al, 37 Kong et al, 38 Koo et al, 39 Koo et al, 40 Lee (1) et al, 41 Lee (2) et al, 42 Schmidt et al, 46 Shin et al, 47 Song et al, 48 Treskatsch et al, 50 Zhang…”

The influence of dexmedetomidine on remifentanil‑induced hyperalgesia and the sex differences

“…Many experimental studies have been published in this field. Some studies suggested that N-methyl-D-aspartate (NMDA) receptor antagonists such as ketamine may play a role as a useful adjuvant to reduce RIH (6)(7)(8). COX-2 inhibitor parecoxib which were also investigated as nonsteroidal anti-inflammatory drugs were often administered as premedication before surgery (9,10).…”