title: Maintenance anaesthetics during remifentanil-based anaesthesia might affect postoperative pain control after breast cancer surgery.
abstract: BACKGROUND
  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. In this investigation, we sought to determine the effect of maintenance with propofol or sevoflurane on postoperative analgesia after remifentanil-based anaesthesia.
  
  
  METHODS
  Two hundred and fourteen women undergoing breast cancer surgery under remifentanil-based general anaesthesia were randomly included in this prospective and double-blind trial. The patients were anaesthetized with sevoflurane (S) or propofol (P) under high (H) or low (L) effect-site concentration (Ce) of remifentanil-based anaesthesia using a target-controlled infusion system; the patients were allocated into the SH, SL, PH, and PL groups. Pain intensity (visual analogue score, VAS) and cumulative morphine requirements were recorded 30 min, 1, 6, 12, and 24 h after operation.
  
  
  RESULTS
  The patient characteristics were similar. Cumulative morphine consumption at 24 h after surgery was higher in the SH group [38.6 (sd 14.9)] compared with the SL [31.5 (3.7)], PH [31.7 (8.3)], and PL groups [30.1 (6.1)] (P<0.001). The VAS scores during 24 h after surgery were also higher in the SH group than the SL, PH, and PL groups (P<0.001).
  
  
  CONCLUSIONS
  Remifentanil hyperalgesia was induced by high dose of remifentanil-based anaesthesia during sevoflurane anaesthesia, whereas that was not apparent during propofol anaesthesia. Also, remifentanil hyperalgesia did not occur during low dose of remifentanil-based anaesthesia. Maintenance of propofol during high-dose remifentanil-based anaesthesia provided better postoperative analgesia.
authors.affiliation: Department of Anesthesia and Pain Medicine and Medical Research Institute, School of Medicine, Pusan National University, Beomeo-Ri, Mulgeum-Eup, Yangsan-Si, Gyeongsangnam-Do 626-770, Republic of Korea.
authors.forename: S-W
authors.initials: SW
authors.lastname: Shin
authors.forename: A-R
authors.initials: AR
authors.lastname: Cho
authors.forename: H-J
authors.initials: HJ
authors.lastname: Lee
authors.forename: H-J
authors.initials: HJ
authors.lastname: Kim
authors.forename: G J
authors.initials: GJ
authors.lastname: Byeon
authors.forename: J-W
authors.initials: JW
authors.lastname: Yoon
authors.forename: K-H
authors.initials: KH
authors.lastname: Kim
authors.forename: J-Y
authors.initials: JY
authors.lastname: Kwon
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D018685:Anesthetics, Inhalation / Q000494:pharmacology; D018686:Anesthetics, Intravenous / Q000494:pharmacology; D001943:Breast Neoplasms / Q000601:surgery*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004347:Drug Interactions; D005260:Female; D006801:Humans; D006930:Hyperalgesia / Q000139:chemically induced*; D008738:Methyl Ethers / Q000494:pharmacology; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000517:prevention & control*; D010880:Piperidines / Q000009:adverse effects*; D015742:Propofol / Q000494:pharmacology; D011446:Prospective Studies; D000077208:Remifentanil; D000077149:Sevoflurane
chemical_list: D000701:Analgesics, Opioid; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D010880:Piperidines; D000077149:Sevoflurane; D009020:Morphine; D000077208:Remifentanil; D015742:Propofol