title: Target-controlled dosing of remifentanil during cardiac surgery reduces postoperative hyperalgesia.
abstract: OBJECTIVE
  One of the strategies to attenuate opioid-induced hyperalgesia (OIH) may be to decrease intraoperative doses of opioids by using target-controlled infusion (TCI).
  
  
  METHODS
  Double-blind and randomized study.
  
  
  METHODS
  A single university hospital.
  
  
  METHODS
  Forty American Society of Anesthesiologists II to III patients scheduled for elective cardiac surgery.
  
  
  METHODS
  patients were randomized to 1 of the 2 groups: 1 group received an infusion of intraoperative remifentanil using TCI (target: 7 ng/mL), and the 2nd one was given an intraoperative continuous infusion (CI) (0.3 μg/kg/min). The anesthestic protocol and postoperative pain management were the same in both groups. The extent of mechanical dynamic hyperalgesia on the middle line perpendicular to the wound was considered the primary endpoint. The secondary endpoints were other results of dynamic and punctuate hyperalgesia until postoperative day 7, visual analog scale (VAS) and verbal rating scale (VRS) scores, and total morphine consumption until postoperative day 2.
  
  
  RESULTS
  Morphometric and demographic characteristics and duration of surgery were comparable in both groups. Intraoperative remifentanil consumption was greater in CI than in TCI group (5,329 [1,833] v 3,662 [1,160] μg, p = 0.003). During the first 44 hours, there were no differences in morphine consumption, VAS, and VRS. The extent of hyperalgesia was significantly lower on postoperative days 1, 2, and 4 in the TCI group than in the CI group on the 3 evaluated lines (p < 0.05). Punctuate hyperalgesia evaluating 3 different points was lower in the TCI than in the CI group from postoperative day 1 until postoperative day 7 (p < 0.05).
  
  
  CONCLUSIONS
  The intraoperative decrease of opioid consumption when comparing the CI versus TCI mode of administration of remifentanil led to less OIH after cardiac surgery.
authors.affiliation: Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, WA 98195-6540, USA. prichebe@u.washington.edu
authors.forename: Philippe
authors.initials: P
authors.lastname: Richebé
authors.forename: Olivier
authors.initials: O
authors.lastname: Pouquet
authors.forename: Srdjan
authors.initials: S
authors.lastname: Jelacic
authors.forename: Sonya
authors.initials: S
authors.lastname: Mehta
authors.forename: Joachim
authors.initials: J
authors.lastname: Calderon
authors.forename: Walter
authors.initials: W
authors.lastname: Picard
authors.forename: Cyril
authors.initials: C
authors.lastname: Rivat
authors.forename: Alex
authors.initials: A
authors.lastname: Cahana
authors.forename: Gérard
authors.initials: G
authors.lastname: Janvier
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000627:therapeutic use*; D000768:Anesthesia, General; D000771:Anesthesia, Intravenous; D001794:Blood Pressure / Q000187:drug effects; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D004311:Double-Blind Method; D016503:Drug Delivery Systems; D004569:Electroencephalography; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006930:Hyperalgesia / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D010147:Pain Measurement / Q000187:drug effects; D017288:Pain Threshold / Q000187:drug effects; D010149:Postoperative Pain / Q000517:prevention & control*; D010812:Physical Stimulation; D010880:Piperidines / Q000008:administration & dosage* / Q000627:therapeutic use*; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D011229:Preanesthetic Medication; D000077208:Remifentanil; D056346:Sternotomy
chemical_list: D000701:Analgesics, Opioid; D010880:Piperidines; D000082:Acetaminophen; D009020:Morphine; D000077208:Remifentanil