title: Pre-treatment with morphine does not prevent the development of remifentanil-induced hyperalgesia.
abstract: OBJECTIVE
  Remifentanil, an ultra short-acting opioid commonly used to supplement general anesthesia, is associated with the development of hyperalgesia that manifests clinically as an increase in postoperative analgesic requirement. This study involving adolescents undergoing scoliosis surgery evaluated whether pre-treatment with morphine prior to commencing remifentanil infusion would decrease the initial 24-hr morphine consumption and pain scores.
  
  
  METHODS
  Forty ASA I-II pediatric patients undergoing surgical correction of idiopathic scoliosis were recruited in a prospective, randomized, double-blind fashion to receive 150 microg x kg(-1) morphine or an equal volume saline prior to commencing remifentanil by infusion. The primary outcome was the initial 24-hr postoperative morphine consumption. Numeric rating scale (NRS) pain scores at rest and on coughing were recorded, as were scores for nausea, vomiting, and sedation and incidences of pruritus.
  
  
  RESULTS
  The groups were demographically similar. No differences were observed between groups vis-à-vis the initial 24-hr morphine consumption, NRS pain scores, sedation, nausea, or vomiting.
  
  
  CONCLUSIONS
  Pre-treatment with 150 microg x kg(-1) morphine did not decrease the initial 24-hr morphine consumption in adolescents who received remifentanil by infusion for surgical correction of idiopathic scoliosis.
authors.affiliation: Department of Anesthesia, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
authors.forename: Conor
authors.initials: C
authors.lastname: McDonnell
authors.forename: Christian
authors.initials: C
authors.lastname: Zaarour
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hull
authors.forename: Priya
authors.initials: P
authors.lastname: Thalayasingam
authors.forename: Carolyne
authors.initials: C
authors.lastname: Pehora
authors.forename: Janet
authors.initials: J
authors.lastname: Ahier
authors.forename: Mark W
authors.initials: MW
authors.lastname: Crawford
mesh_terms: D000293:Adolescent; D016058:Analgesia, Patient-Controlled / Q000706:statistics & numerical data; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D000768:Anesthesia, General / Q000379:methods; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D006930:Hyperalgesia / Q000139:chemically induced* / Q000517:prevention & control*; D007430:Intraoperative Care; D008297:Male; D009020:Morphine / Q000008:administration & dosage*; D019637:Orthopedic Procedures / Q000379:methods; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control; D010880:Piperidines / Q000008:administration & dosage / Q000009:adverse effects*; D011292:Premedication; D011446:Prospective Studies; D000077208:Remifentanil; D012600:Scoliosis / Q000601:surgery
chemical_list: D000701:Analgesics, Opioid; D010880:Piperidines; D009020:Morphine; D000077208:Remifentanil