title: Remifentanil infusion does not induce opioid tolerance after cardiac surgery.
abstract: OBJECTIVE
  Remifentanil is being used increasingly during fast-track cardiac surgery. Postoperative hyperalgesia and opioid tolerance have been reported in volunteer studies and in patients after major abdominal surgery with remifentanil infusion. In the present study, the authors evaluated whether high-dose remifentanil infusion induces opioid tolerance in 90 patients undergoing coronary artery bypass surgery with sternotomy.
  
  
  METHODS
  Prospective, randomized, and double-blind study.
  
  
  METHODS
  Single-institution, tertiary level, university hospital.
  
  
  METHODS
  Ninety patients undergoing coronary artery bypass surgery.
  
  
  METHODS
  Patients were randomized to receive a 3-hour infusion of remifentanil (0.3 microg/kg/min, n = 45) or placebo (n = 45) intraoperatively as adjunct to a standardized sufentanil/propofol-based general anesthesia.
  
  
  RESULTS
  Opioid consumption, pain, and sedation scores, as well as adverse events and patients' satisfaction with pain therapy, were recorded for 48 postoperative hours. There were no differences in postoperative opioid consumption between the groups (median oxycodone consumption in the remifentanil group, 98 mg [range, 29-166] and in the placebo group, 99 mg [42-219]). Pain scores were comparable at rest, but during a deep breath pain scores were lower in the remifentanil group (p = 0.020). Sedation scores, satisfaction with analgesia, and adverse events were similar between the 2 groups. The most common adverse event was nausea, with a 33% incidence in the placebo and 40% incidence in the remifentanil group.
  
  
  CONCLUSIONS
  Three-hour remifentanil infusion did not increase postoperative pain or opioid consumption in cardiac surgery patients. The present results suggest that high-dose remifentanil does not elicit opioid tolerance when given during cardiac surgery.
authors: Department of Anesthesiology and Intensive Care, University of Kuopio, Kuopio, Finland.
authors: Pasi
authors: P
authors: Lahtinen
authors: Hannu
authors: H
authors: Kokki
authors: Markku
authors: M
authors: Hynynen
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage*; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods; D004311:Double-Blind Method; D004361:Drug Tolerance / Q000502:physiology*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000187:drug effects / Q000379:methods; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control; D010880:Piperidines / Q000008:administration & dosage*; D000077208:Remifentanil
chemical_list: D000701:Analgesics, Opioid; D010880:Piperidines; D000077208:Remifentanil