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Remifentanil induced hyperalgesia

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https://www.readbyqxmd.com/read/27744107/a-targeted-remifentanil-administration-protocol-based-on-the-analgesia-nociception-index-during-vascular-surgery
#1
Georges Daccache, Edouard Caspersen, Michel Pegoix, Kelly Monthé-Sagan, Ludovic Berger, Dominique Fletcher, Jean-Luc Hanouz
BACKGROUND: The intraoperative modulation of opioids continues to be based on clinical signs. This may result in adverse events such as sympathetic reactivity or opioid induced hyperalgesia. Recently, the Analgesia/Nociception Index (ANI), a non-invasive 0-100 index derived from heart rate variability analysis, has been proposed for nociception assessment. However, the ability of the ANI to adequately guide intraoperative opioid administration has never been demonstrated. We designed a prospective study to evaluate the ability of the ANI to guide remifentanil administration in vascular surgery...
October 12, 2016: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/27741140/effects-of-remifentanil-versus-nitrous-oxide-on-postoperative-nausea-vomiting-and-pain-in-patients-receiving-thyroidectomy-propensity-score-matching-analysis
#2
Min Kyoung Kim, Myung Sub Yi, Hyun Kang, Geun-Joo Choi
Remifentanil and nitrous oxide (N2O) are 2 commonly used anesthetic agents. Both these agents are known risk factors for postoperative nausea and vomiting (PONV). However, remifentanil and N2O have not been directly compared in a published study. Remifentanil can induce acute tolerance or hyperalgesia, thus affecting postoperative pain. The objective of this retrospective study is to compare the effects of remifentanil and N2O on PONV and pain in patients receiving intravenous patient-controlled analgesia (IV-PCA) after thyroidectomy...
October 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27734470/remifentanil-tolerance-and-hyperalgesia-short-term-gain-long-term-pain
#3
E H Y Yu, D H D Tran, S W Lam, M G Irwin
The unique pharmacology of remifentanil makes it a popular intra-operative analgesic. Short-acting opioids like remifentanil have been associated with acute opioid tolerance and/or opioid-induced hyperalgesia, two phenomena which have different mechanisms and are pharmacologically distinct. Clinical studies show heterogeneity of remifentanil infusion regimens, durations of infusion, maintenance of anaesthesia, cumulative dose of remifentanil and pain measures, which makes it difficult to draw conclusions about the incidence of acute tolerance or hyperalgesia...
November 2016: Anaesthesia
https://www.readbyqxmd.com/read/27703629/comparison-of-effects-of-intraoperative-nefopam-and-ketamine-infusion-on-managing-postoperative-pain-after-laparoscopic-cholecystectomy-administered-remifentanil
#4
Sung Kwan Choi, Myung Ha Yoon, Jung Il Choi, Woong Mo Kim, Bong Ha Heo, Keun Seok Park, Ji A Song
BACKGROUND: Although intraoperative opioids provide more comfortable anesthesia and reduce the use of postoperative analgesics, it may cause opioid induced hyperalgesia (OIH). OIH is an increased pain response to opioids and it may be associated with N-methyl-D-aspartate (NMDA) receptor. This study aimed to determine whether intraoperative nefopam or ketamine, known being related on NMDA receptor, affects postoperative pain and OIH after continuous infusion of intraoperative remifentanil...
October 2016: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/27698764/protective-effects-of-dexmedetomidine-combined-with-flurbiprofen-axetil-on-remifentanil-induced-hyperalgesia-a-randomized-controlled-trial
#5
Zenggui Yu, Weilan Wu, Xiaodan Wu, Hongyi Lei, Cansheng Gong, Shiyuan Xu
High dosages of intra-operative remifentanil are associated with opioid-induced hyperalgesia (OIH). The aim of the present study was to investigate the effect of combined dexmedetomidine and flurbiprofen axetil treatment on remifentanil-induced hyperalgesia. Patients with an American Society of Anesthesiologists physical status of I-II who were diagnosed with hysteromyoma and scheduled for laparoscopic assisted vaginal hysterectomy (LAVH) were randomly divided into three groups. Group hyperalgesia (Group H, n=29) received intra-operative remifentanil, Group hyperalgesia and dexmedetomidine (Group HD, n=28) received remifentanil and a continuous infusion of dexmedetomidine, and Group hyperalgesia, dexmedetomidine and flurbiprofen axetil (Group HDF, n=29) received remifentanil, flurbiprofen axetil and dexmedetomidine...
October 2016: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/27687719/the-role-of-p38mapk-activation-in-spinal-dorsal-horn-in-remifentanil-induced-postoperative-hyperalgesia-in-rats
#6
Liqin Deng, Lihua Zhang, Haiying Zhao, Fengxiang Song, Gang Chen, Hanyue Zhu
OBJECTIVES: Remifentanil may induce hyperalgesia. Recent studies implicate a close relationship between post-surgical hyperalgesia and phosphorylation and activation of p38 mitogen-activated protein kinase (p38MAPK) in the spinal microglia. This study aimed to investigate whether the combination of post-surgical and remifentanil-induced hyperalgesia worsens post-operative pain and whether phosphorylated p38MAPK (phospho-p38MAPK) in the spinal dorsal horn in rats is involved in remifentanil-induced postoperative hyperalgesia...
October 2016: Neurological Research
https://www.readbyqxmd.com/read/27687343/low-dose-butorphanol-alleviates-remifetanil-induced-hyperalgesia-in-patients-undergoing-laparoscopic-cholecystectomy
#7
Mingjian Kong, Li Yang, Jing Li, Zheng Zhong, Yanqiang Cheng, Zhen Wu, Ran Guo
OBJECTIVE: To evaluate the effects of low-dose butorphanol on hyperalgesia induced by high-dose remifetanil in patients undergoing laparoscopic cholecystectomy. DESIGN: Randomized double-blind clinical trial. SETTING: Intraoperative. PATIENTS: Seventy-five patients scheduled for laparoscopic cholecystectomy were enrolled. INTERVENTIONS: Randomly allocated into 3 groups, low dose of remifentanil (LR) group and high dose of remifentanil (HR) group received low (0...
November 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27637388/spinal-mitochondrial-derived-ros-contributes-to-remifentanil-induced-postoperative-hyperalgesia-via-modulating-nmda-receptor-in-rats
#8
Liu Ye, Li Xiao, Xue Bai, Shi-Ying Yang, Yuan Li, Yuan Chen, Y Cui, Y Chen
BACKGROUND: Activation of N-methyl-d-aspartate (NMDA) receptor by reactive oxygen species (ROS) in the spinal cord plays an important role in the development of hyperalgesia in several neuropathic pain models. The study examined the involvement of ROS-NMDA signaling pathway in remifentanil-induced postoperative hyperalgesia. METHODS: Nociceptive responses were measured by paw withdrawal mechanical threshold (PWT) and paw withdrawal thermal latency (PWL) before and up to day 5 after remifentanil infusion...
September 13, 2016: Neuroscience Letters
https://www.readbyqxmd.com/read/27616703/spinal-wnt-pathway-contributes-to-remifentanil-induced-hyperalgesia-through-regulating-fractalkine-and-cx3cr1-in-rats
#9
Gu Gong, Ling Hu, Fuen Qin, Liang Yin, Xiaobo Yi, Libang Yuan, Wei Wu
BACKGROUND: Tremendous experimental and clinical studies identify that remifentanil anesthesia might elicit postoperative opioid-induced hyperalgesia (OIH) and aggravate nociceptive hypersensitivity, whereas definite mechanisms remain equivocal. WNT signaling and fractalkine pathway have been manifested to participate in varieties of pain pathogenesis, respectively, but no report is on whether they could lead to OIH. This study intended to investigate the effect of WNT3a/β-catenin on fractalkine and its receptor CX3CR1 in OIH in rats model of incision pain...
October 28, 2016: Neuroscience Letters
https://www.readbyqxmd.com/read/27599837/a-comparison-of-intrathecal-magnesium-and-ketamine-in-attenuating-remifentanil-induced-hyperalgesia-in-rats
#10
Jiehao Sun, Hai Lin, Xiaona Feng, Jiaojiao Dong, Emmanuel Ansong, Xuzhong Xu
BACKGROUND: Activation of NMDA receptors play an important role in the development of remifentanil-induced hyperalgesia. We hypothesized that in addition to ketamine, intrathecal MgSO4 could also relieve thermal and mechanical hyperalgesia in rats. METHODS: Initially, 24 Sprague-Dawley rats were divided into control group, remifentanil group, surgical incision group and remifentanil combined with surgical incision group to create an experimental model. Subsequently, 40 rats were divided into control group, model group, model group plus 100 μg MgSO4, 300 μg MgSO4 and 10 μg ketamine respectively...
2016: BMC Anesthesiology
https://www.readbyqxmd.com/read/27537764/pick1-regulates-the-expression-and-trafficking-of-ampa-receptors-in-remifentanil-induced-hyperalgesia
#11
Zhifen Wang, Yuan Yuan, Keliang Xie, Xiaohong Tang, Linlin Zhang, Jiying Ao, Nan Li, Yu Zhang, Suqian Guo, Guolin Wang
BACKGROUND: Remifentanil is used widely in clinical anesthesia because it induces more rapid and more common hyperalgesia than other opioid analgesics. Activation of N-methyl-D-aspartate (NMDA) receptors takes a pivotal part in remifentanil-induced hyperalgesia. Like NMDA receptors, the α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors (AMPARs) are excitatory ion glutamate receptors in postsynaptic membrane, which are involved in the transmission of both acute and chronic pain...
September 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27518488/preoperative-but-not-postoperative-flurbiprofen-axetil-alleviates-remifentanil-induced-hyperalgesia-after-laparoscopic-gynecological-surgery-a-prospective-randomized-double-blinded-trial
#12
Linlin Zhang, Ruichen Shu, Qi Zhao, Yize Li, Chunyan Wang, Haiyun Wang, Yonghao Yu, Guolin Wang
BACKGROUND: Acute remifentanil exposure during intraoperative analgesia might generate sensitivity-enhancing to noxious stimuli and nociceptive responses to innoxious irritation. Cyclooxygenase inhibition was demonstrated to attenuate experimental remifentanil-induced hyperalgesia (RIH) in rodents and human volunteers. the study aimed to compare effects of preoperative and postoperative flurbiprofen axetil on RIH after surgery. METHODS: Ninety patients undergoing elective laparoscopic gynaecological surgery were randomly assigned to receive either intravenous placebo before anesthesia induction (group C); or intravenous flurbiprofen axetil 1...
August 11, 2016: Clinical Journal of Pain
https://www.readbyqxmd.com/read/27388980/influence-of-intraoperative-remifentanil-and-sufentanil-on-sensory-perception-a-randomized-trial
#13
H Ohnesorge, A Alpes, R Baron, J Gierthmühlen
OBJECTIVE: The clinical relevance of pro- and hyperalgesic effects of opioids is still a matter of debate. Particularly for remifentanil, an increased postoperative need for analgesics has been demonstrated suggesting opioid-induced hyperalgesia as a possible cause. The aim of the study was therefore to investigate the effect of intraoperatively applied remifentanil compared to sufentanil on somatosensory thresholds investigated with the quantitative sensory testing (QST) battery of the German Research Network on Neuropathic Pain (DFNS)...
July 8, 2016: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/27380044/involvement-of-spinal-pkm%C3%AE-expression-and-phosphorylation-in-remifentanil-induced-long-term-hyperalgesia-in-rats
#14
Qi Zhao, Linlin Zhang, Ruichen Shu, Chunyan Wang, Yonghao Yu, Haiyun Wang, Guolin Wang
Up-regulation of GluN2B-containing N-methyl-D-aspartate receptors (NMDARs) expression and trafficking is the key mechanism for remifentanil-induced hyperalgesia (RIH), nevertheless, the signaling pathway and pivotal proteins involved in RIH remain equivocal. PKMζ, an isoform of protein kinase C (PKC), maintains pain memory storage in neuropathic pain and inflammatory pain, which plays a parallel role regulated by NMDARs in long-term memory trace. In the present study, Zeta Inhibitory Peptide (ZIP), a PKMζ inhibitor, and a selective GluN2B antagonist Ro-256981 are injected intrathecally before remifentanil infusion (1 μg kg(-1) min(-1) for 1 h, iv) in order to detect whether GluN2B contributes to RIH through affecting synthesis and activity of PKMζ in spinal dorsal horn...
July 5, 2016: Cellular and Molecular Neurobiology
https://www.readbyqxmd.com/read/27185670/remifentanil-and-worse-patient-reported-outcomes-regarding-postoperative-pain-management-after-thyroidectomy
#15
Filippo Sanfilippo, Caren Conticello, Cristina Santonocito, Carmelo Minardi, Filippo Palermo, Renato Bernardini, Antonino Gullo, Marinella Astuto
BACKGROUND: Intraoperative remifentanil has been associated with postoperative hyperalgesia, higher visual analogic pain scores, and increased postoperative morphine consumption. However, this has not been investigated from patient's perspective by using a patient-reported outcomes (PROs) approach with a validated questionnaire. METHODS: We joined the largest prospective observational study on postoperative pain, PAIN OUT Project (NCT02083835), and collected data for 2 years...
June 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27029459/a-randomized-phase-i-trial-evaluating-the-effects-of-inhaled-50-50-n2-o-o2-on-remifentanil-induced-hyperalgesia-and-allodynia-in-human-volunteers
#16
A Wehrfritz, S Schaefer, A Troester, N Noel, B Bessiere, G Apiou-Sbirlea, G Simonnet, J Schuettler, P Richebé
BACKGROUND: Opioids are known to relieve pain, and also aggravate pre-existing hyperalgesia. In animal studies, the N-methyl-d-aspartate-receptor antagonist nitrous oxide (N2 O) was able to prevent hyperalgesia. The present study evaluated the effect of N2 O on hyperalgesia after remifentanil infusion in healthy volunteers. METHODS: Twenty-one healthy volunteers were enrolled in this placebo-controlled cross-over study. Transcutaneous electrical stimulation at high current densities induced spontaneous acute pain and stable areas of hyperalgesia...
October 2016: European Journal of Pain: EJP
https://www.readbyqxmd.com/read/26934941/gradual-withdrawal-of-remifentanil-infusion-may-prevent-opioid-induced-hyperalgesia
#17
RANDOMIZED CONTROLLED TRIAL
M Comelon, J Raeder, A Stubhaug, C S Nielsen, T Draegni, H Lenz
BACKGROUND: The aim of this study was to examine if gradual withdrawal of remifentanil infusion prevented opioid-induced hyperalgesia (OIH) as opposed to abrupt withdrawal. OIH duration was also evaluated. METHODS: Nineteen volunteers were enrolled in this randomized, double-blinded, placebo-controlled, crossover study. All went through three sessions: abrupt or gradual withdrawal of remifentanil infusion and placebo. Remifentanil was administered at 2.5 ng ml(-1) for 30 min before abrupt withdrawal or gradual withdrawal by 0...
April 2016: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/26886620/differential-postoperative-effects-of-volatile-anesthesia-and-intraoperative-remifentanil-infusion-in-7511-thyroidectomy-patients-a-propensity-score-matching-analysis
#18
Jun-Young Jo, Seong-Soo Choi, Jung Min Yi, Eun Young Joo, Ji Hyun Kim, Se Ung Park, Ji-Hoon Sim, Myong-Hwan Karm, Seungwoo Ku
Although remifentanil is used widely by many clinicians during general anesthesia, there are recent evidences of opioid-induced hyperalgesia as an adverse effect. This study aimed to determine if intraoperative remifentanil infusion caused increased pain during the postoperative period in patients who underwent a thyroidectomy. A total of 7511 patients aged ≥ 20 years, who underwent thyroidectomy between January 2009 and December 2013 at the Asan Medical Center were retrospectively analyzed. Enrolled patients were divided into 2 groups: group N (no intraoperative remifentanil and only volatile maintenance anesthesia) and group R (intraoperative remifentanil infusion including total intravenous anesthesia and balanced anesthesia)...
February 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/26859874/the-effects-of-the-toll-like-receptor-4-antagonist-ibudilast-on-sevoflurane-s-minimum-alveolar-concentration-and-the-delayed-remifentanil-induced-increase-in-the-minimum-alveolar-concentration-in-rats
#19
Daniel Ruiz-Pérez, Javier Benito, Gonzalo Polo, Carlota Largo, Delia Aguado, Luis Sanz, Ignacio A Gómez de Segura
BACKGROUND: Ultralow doses of naloxone, an opioid and toll-like receptor 4 antagonist, blocked remifentanil-induced hyperalgesia and the associated increase in the minimum alveolar concentration (MAC), but not tolerance. The aim was to determine the effects of the toll-like receptor 4 antagonist, ibudilast, on the MAC in the rat and how it might prevent the effects of remifentanil. METHODS: Male Wistar rats were randomly allocated to 5 treatment groups (n = 7 per group): 10 mg/kg ibudilast intraperitoneally, 240 µg/kg/h remifentanil IV, ibudilast plus remifentanil, remifentanil plus naloxone IV, or saline...
May 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/26655493/does-fentanyl-lead-to-opioid-induced-hyperalgesia-in-healthy-volunteers-a-double-blind-randomized-crossover-trial
#20
RANDOMIZED CONTROLLED TRIAL
Eckhard Mauermann, Joerg Filitz, Patrick Dolder, Katharina M Rentsch, Oliver Bandschapp, Wilhelm Ruppen
BACKGROUND: Although opioids in general and remifentanil in particular have been shown to induce hyperalgesia, data regarding fentanyl are scarce. Thus, the authors investigated the effect of fentanyl dosing on pain perception and central sensitization in healthy volunteers using established pain models. METHODS: Twenty-one healthy, male volunteers were included in this randomized, double-blind, crossover study and received either intravenous low-dose (1 μg/kg) or high-dose (10 μg/kg) fentanyl...
February 2016: Anesthesiology
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