Abstract
Purpose: Remifentanil, an ultra short-acting opioid commonly used to supplement general anesthesia, is associated with the development of hyperalgesia that manifests clinically as an increase in postoperative analgesic requirement. This study involving adolescents undergoing scoliosis surgery evaluated whether pre-treatment with morphine prior to commencing remifentanil infusion would decrease the initial 24-hr morphine consumption and pain scores.
Methods: Forty ASA 1–11 pediatric patients undergoing surgical correction of idiopathic scoliosis were recruited in a prospective, randomized, double-blind fashion to receive 150µg·kg−1 morphine or an equal volume saline prior to commencing remifentanil by infusion. The primary outcome was the initial 24-hr postoperative morphine consumption. Numeric rating scale (NRS) pain scores at rest and on coughing were recorded, as were scores for nausea, vomiting, and sedation and incidences of pruritus.
Results: The groups were demographically similar. No differences were observed between groups vis-à-vis the initial 24-hr morphine consumption, NRS pain scores, sedation, nausea, or vomiting.
Conclusion: Pre-treatment with 150µg·kg−1 morphine did not decrease the initial 24-hr morphine consumption in adolescents who received remifentanil by infusion for surgical correction of idiopathic scoliosis.
Résumé
Objectif: Le rémifentanil est un opioïde à action extra-courte couramment utilisé comme adjuvant à une anesthésie générate. II est associé à l’apparition d’hyperalgéesie, laquelle prend la forme clinique d’une augmentation des besoins analgésiques postopératoires. Cette étude portait sur des adolescents subissant une chirurgie de correction de scoliose. Son objectif était de déterminer si un prétraitement à la morphine avant la perfusion de rémifentanil diminuerait la consommation de morphine et l’intensite de la douleur dans les 24 premières heures suivant l’opération.
Méthode: Quarante adolescents ASA 1–11 subissant une chirurgie corrective pour une scoliose idiopathique ont été recrutés de façon prospective, randomisée et à double insu, à recevoir de la morphine 150 µg·kg−1 ou un volume équivalent de sérum physiologique avant le début d’une perfusion de rémifentanil. La consommation de morphine durant les 24 premières heures postopératoires était l’objectif primaire. Les scores de douleur sur l’échelle d’évaluation numérique (EEN) au repos et en toussant ont été notes, de même que les scores concernant les nausées, les vomissements, la sédation et l’aptparition de prurit.
Résultats: Les groupes étaient semblables d’un point de vue démographique. Aucune différence n’a été observée entre les groupes quant à la consommation de morphine des 24 premières heures, les scores de douleur EEN, la sédation, les nausées ou les vomissements.
Conclusion: Le prétraitement avec 150µ·kg−1 de morphine n’a pas diminué la consommation de morphine durant les 24 premières heures postopératoires chez des adolescents recevant une perfusion de rémifentanil pour une chirurgie corrective d’une scoliose idiopathique.
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McDonnell, C., Zaarour, C., Hull, R. et al. Pre-treatment with morphine does not prevent the development of remifentanil-induced hyperalgesia. Can J Anesth 55, 813–818 (2008). https://doi.org/10.1007/BF03034052
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DOI: https://doi.org/10.1007/BF03034052