title: [Influence of remifentanil on postoperative pain with intravenous patient-controlled analgesia following total knee arthroplasty].
abstract: BACKGROUND
  There is a controversy about the development of acute opioid tolerance during remifentanil infusion for postoperative pain. We investigated whether intraoperative remifentanil infusion leads to rapid development of tolerance. We also investigated whether adjuvant analgesic is effective or not.
  
  
  METHODS
  One hundred and thirty patients scheduled for TKA were divided into 4 groups; Non-remifentanil infusion group (30 patients; group A). This group was given a bolus of fentanyl 0.2 mg at the induction of anesthesia. In remifentanil anesthesia group (100 patients), remifentanil was given 0.2-0.3 microg x kg(-1) min(-1) and divided into three groups; 23 patients group B given a bolus of 0.2 mg fentanyl at induction of anesthesia, 38 patients group C given a bolus of fentanyl 0.2 mg at skin closure, and 39 patients group D given a bolus of fentanyl 0.2 mg at skin closure and administrated diclofenac sodium suppository rectally at induction of anesthesia. Intravenous patient controlled analgesia (PCA) of fentanyl was commenced before skin incision for all patients. Pain was scored at rest and during movement for 24 postoperative hours.
  
  
  RESULTS
  Numerical rating scale (NRS) scores during movement after 24 hours in group B were significantly higher than in group A. And, the NRS scores in group D tended to be lower than the other groups, but there were no significant differences.
  
  
  CONCLUSIONS
  Intraoperative remifentanil increased postoperative pain during movement. Remifentanil seems to cause acute torelance. NSAIDs given before operation may be useful for postoperative analgesia.
authors.affiliation: Department of Anesthesia, Kishiwada Tokushukai Hospital, Kishiwada 596-0042.
authors.forename: Asami
authors.initials: A
authors.lastname: Tomita
authors.forename: Makoto
authors.initials: M
authors.lastname: Satani
authors.forename: Akihiro
authors.initials: A
authors.lastname: Morimoto
authors.forename: Noriaki
authors.initials: N
authors.lastname: Omae
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D000768:Anesthesia, General; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D019645:Arthroplasty, Replacement, Knee; D004008:Diclofenac / Q000008:administration & dosage; D004361:Drug Tolerance; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D010147:Pain Measurement / Q000379:methods*; D010149:Postoperative Pain / Q000175:diagnosis* / Q000517:prevention & control*; D010880:Piperidines / Q000008:administration & dosage* / Q000009:adverse effects; D011300:Preoperative Care; D000077208:Remifentanil; D013997:Time Factors
chemical_list: D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D010880:Piperidines; D004008:Diclofenac; D000077208:Remifentanil