title: Interaction between postoperative shivering and hyperalgesia caused by high-dose remifentanil.
abstract: BACKGROUND
  High-dose remifentanil-based anesthesia is associated with opioid-induced hyperalgesia (OIH) and postanesthetic shivering (PAS). These effects can be prevented by N-methyl-d-aspartate (NMDA) receptor antagonists. This study aimed to investigate correlations between OIH and PAS caused by high-dose remifentanil and the effects of low-dose ketamine on OIH and PAS.
  
  
  METHODS
  Seventy-five patients scheduled for single-port laparoscopic gynecologic surgery were randomly allocated into three groups, each of which received intraoperative remifentanil: group L at 0.1 µg/kg/min; group H at 0.3 µg/kg/min; and group HK at 0.3 µg/kg/min plus 0.25 mg/kg ketamine just before incision, followed by a continuous infusion of 5 µg/kg/min ketamine until skin closure.
  
  
  RESULTS
  PAS, postoperative tactile pain threshold, and the extent of hyperalgesia in group H were significantly different (P < 0.05) than in the other two groups. PAS was significantly correlated with OIH, including mechanically evoked pain such as postoperative tactile pain threshold (r = -0.529, P = 0.01) (r = -0.458, P = 0.021) and the extent of hyperalgesia (r = 0.537, P = 0.002) (r = 0.384, P = 0.031), respectively, in group H and group HK. Notably, both groups were treated with high-dose remifentanil. Tympanic membrane temperature, time to first postoperative analgesic requirement, postoperative pain scores, analgesic consumption, and cumulative patient-controlled analgesia volume containing morphine were comparable in all three groups.
  
  
  CONCLUSIONS
  OIH, including the enhanced perception of pain, and PAS were both associated with high-dose remifentanil, were significantly correlated and were attenuated by a low dose of ketamine. This suggests that a common mechanism in part mediated through activation of the central glutamatergic system (e.g., NMDA receptors), underlies the two effects caused by high doses of remifentanil.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Wonkwang University College of Medicine, Iksan, Korea.
authors.forename: Yoon-Kang
authors.initials: YK
authors.lastname: Song
authors.affiliation: Department of Anesthesiology and Pain Medicine, Wonkwang University College of Medicine, Iksan, Korea.
authors.forename: Cheol
authors.initials: C
authors.lastname: Lee
authors.affiliation: Department of Anesthesiology and Pain Medicine, Wonkwang University College of Medicine, Iksan, Korea.
authors.forename: Dong-Hyuk
authors.initials: DH
authors.lastname: Seo
authors.affiliation: Department of Obstetrics and Gynecology, Wonkwang University College of Medicine, Iksan, Korea.
authors.forename: Seong-Nam
authors.initials: SN
authors.lastname: Park
authors.affiliation: Department of Anesthesiology and Pain Medicine, Wonkwang University Sanbon Hospital, Gunpo, Korea.
authors.forename: Seo-Young
authors.initials: SY
authors.lastname: Moon
authors.affiliation: Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Korea.
authors.forename: Chang-Hyun
authors.initials: CH
authors.lastname: Park
keywords: Ketamine; Opioid-induced hyperalgesia; Postanesthetic shivering; Remifentanil