Magnesium Sulfate Prevents Remifentanil-Induced Postoperative Hyperalgesia in Patients Undergoing Thyroidectomy

Abstract

A relatively high dose of intraoperative remifentanil enhances periincisional hyperalgesia. Intraoperative MgSO(4) prevents remifentanil-induced hyperalgesia. However, hyperalgesia did not reach clinical relevance in terms of postoperative pain or analgesic consumption in patients undergoing thyroidectomy.

Intraoperative use of remifentanil and opioid induced hyperalgesia/acute opioid tolerance: systematic review

“…Without direct measures to assess hyperalgesia such as QST, the results are not easy to distinguish from acute tolerance (Vinik and Kissin, 1998). Clinical studies examining remifentanil-induced hyperalgesia by QST showed that, at a relatively high dose, remifentanil decreased the pain threshold (Gustorff et al, 2002; Joly et al, 2005; Schmidt et al, 2007; Song et al, 2011; Yalcin et al, 2012). These studies used remifentanil infusions at clinically standard rates, and all of them showed clear hyperalgesia either shortly after discontinuing infusion or 1 and 2 days postoperatively.…”

“…Clinical studies assessing the preventive effect of drugs on OIH in the immediate postoperative period, showed that the clinical benefit is either absent (Echevarria et al, 2011), limited to a moderate opioid-sparing effect (Joly et al, 2005; Shin et al, 2010), or a slight reduction in pain scores (Shin et al, 2010; Song et al, 2011). According to these results, Martinez and Fletcher (2012) suggested that the immediate postoperative period may not be the optimal period to detect the preventive effects on OIH, even though additional clinical data need to confirm it.…”

Intraoperative Use of Remifentanil for TIVA: Postoperative Pain, Acute Tolerance, and Opioid-Induced Hyperalgesia

“…These findings were replicated by others. 8,29 For example, a study in patients undergoing open heart surgery and randomized to 2 infusion algorithms resulting in different cumulative doses of remifentanil (3.66 vs. 5.33 mg) revealed that patients exposed to the higher cumulative dose experienced aggravated wound hyperalgesia over the entire course of the first postoperative week. 8 Should we be concerned if high intraoperative doses of remifentanil aggravate wound hyperalgesia?…”

The efficacy of N-methyl-d-aspartate receptor antagonists on improving the postoperative pain intensity and satisfaction after remifentanil-based anesthesia in adults: a meta-analysis

“…In 8 trials, a perioperative use of ketamine was administered [11,[22][23][24][25][26][27][28]. In 5 trials, a preoperative bolus of magnesium sulfate was followed by a continuous infusion throughout surgery [29][30][31][32][33]. In 1 trial, a preoperative amantadine was administrated [34].…”