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Anesthetic Pharmacology
Anesthesia and Pain Medicine 2011;6(2):138-142.
Published online April 30, 2011.
Effects of intraoperative continuous infusion of low dose remifentanil and intravenous bolus dose of fentanyl on postoperative pain
Jin Yong Jung, Jong Hae Kim, Sang Hyuk Son
Department of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu, Daegu, Korea.
The aim of this study was to evaluate whether continuous infusion of remifentanil during propofol anesthesia could produce opioid-induced hyperalgesia (OIH) and whether an intravenous bolus of fentanyl could control OIH in the management of postoperative pain.
One hundred fifty-nine women undergoing gynecologic surgery were randomly divided into four groups. Group C: nitrous oxide and propofol infusion (3-4 microg/ml, n = 40), Group F: propofol infusion and intravenous bolus administration of fentanyl (1 microg/kg) after suturing the peritoneum (n = 40), Group R: propofol and remifentanil infusion (2-4 ng/ml, n = 40) and Group RF: propofol, remifentanil infusion and intravenous bolus administration of fentanyl (n = 39). Patient controlled analgesia was started after the operation. The postoperative visual analog scale (VAS) was measured in the recovery room, then at 2 h, 6 h, 12 h, and 24 h after the operation.
The VAS scores for Groups R and F in the recovery room were lower than for group C (P < 0.05), but there were no differences 2 h after the operation. The VAS scores for Group RF 6 h and 12 h after the operation were higher than those for group C (P < 0.05).
Our results suggest that low dose (2-4 ng/ml) continuous infusion of remifentanil during propofol anesthesia does not produce marked hyperalgesia. However, an intravenous bolus of fentanyl can aggravate OIH induced by remifentanil.
Key Words: Fentanyl, Hyperalgesia, Postoperative pain, Remifentanil

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