Gradual Withdrawal of Remifentanil Infusion Reduced Postoperative Pain and Opioid Requirement During Breast Surgery
Study Details
Study Description
Brief Summary
Although remifentanil provides profound analgesia during operation, postoperative occurrence of hyperalgesia and tolerance after remifentanil administration could be a challenge to the postoperative pain control. Evaluation of analgesia and anti-nociception during anesthesia is still a challenging issue. Surgical Pleth Index (SPI) is a non-invasive and simple access tool used to monitor autonomous nervous system during anesthesia. This technique is based on photoplethysmographic wave and heart beat analysis. SPI values range between 0 (no stress) and 100 (high stress level). The purpose of this study was to determine the appropriate use of Remifentanil for pain control in patients with SPI.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
| N/A |
Detailed Description
Patients were randomized into either SPI-guided analgesia or standard practice (Control). In both groups, anesthesia was maintained with total intravenous anaesthesia(TIVA) to keep bispectral index values between 40 and 60.
In the Remifentanil gradual reduction group (test group), 20 minutes before the end of the operation, remifentanil was gradually decreased by 25% every 5 minutes. The control group stopped remifentanil 10 minutes before the end of the operation.
SPI was recorded before the intubation, after the intubation, directly before the end of surgery. The number of unwanted somatic events, hemodynamics, Patient-controlled analgesia(PCA) consumption, narcotic analgesics consumption, and recovery times were recorded.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Active Comparator: Remifentanil gradually withdrawal group 20 minutes before the end of the operation, remifentanil was gradually decreased by 25% every 5 minutes. |
Drug: Remifentanil
Remifentanil is a potent, short-acting synthetic opioid analgesic drug. It is given to patients during surgery to relieve pain and as an adjunct to an anesthetic.
|
| Active Comparator: Remifentanil immediately stop group The control group stopped remifentanil 10 minutes before the end of the operation. |
Drug: Remifentanil
Remifentanil is a potent, short-acting synthetic opioid analgesic drug. It is given to patients during surgery to relieve pain and as an adjunct to an anesthetic.
|
Outcome Measures
Primary Outcome Measures
- Numeric Rating Scale(NRS) [postoperative 1 hour]
The difference of postoperative highest pain score (NRS) between two groups
Secondary Outcome Measures
- SPI [intraoperative (after the laryngeal mask airway)]
The difference of Surgical Pleth Index between two groups
- SPI [intraoperative (after the incision)]
The difference of Surgical Pleth Index between two groups
- analgesics consumption [during post-anesthesia care unit]
The difference of analgesics consumption between two groups
- analgesics consumption [up to postoperative 48hours]
The difference of analgesics consumption between two groups
- nausea & vomiting [postoperative 1 hour]
The difference of nausea and vomiting between two groups
- Numeric Rating Scale(NRS) [during postoperative 48hours]
The difference of highest postoperative pain score (NRS) between two groups
- the duration of eye opening [end of surgery]
the duration of eye opening after stoping propofol
- intraoperative remifentanil consumption [intraoperative]
the dose of intraoperative remifentanil according to postoperative pain
Eligibility Criteria
Criteria
Inclusion Criteria:
- Patients who received the breast conserving surgery
Exclusion Criteria:
-
Patients with arrhythmia who have poor SPI measurement
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When the patient refused
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Patients with decreased renal function of Cr> 2
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Surgery for more than 3 hours, surgery expected to bleed more than 500 ml
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Samsung Medical Center | Seoul | Gangnam-gu | Korea, Republic of | 06351 |
Sponsors and Collaborators
- Samsung Medical Center
Investigators
- Principal Investigator: sehee kang, fellow, Samsung Medical Center
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- SMC2018-07-153