Remifentanil infusion does not induce opioid tolerance after cardiac surgery.
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.
Lahtinen
Pasi
P
Department of Anesthesiology and Intensive Care, University of Kuopio, Kuopio, Finland.
Kokki
Hannu
H
Hynynen
Markku
M
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
D000701:Analgesics, Opioid; D010880:Piperidines; D000077208:Remifentanil