Stepwise tapering of remifentanil at the end of surgery decreased postoperative pain and the need of rescue analgesics after thyroidectomy.
BACKGROUND
This study was designed to investigate whether stepwise tapering of remifentanil at the end of surgery could decrease postoperative pain scores and requirements of rescue analgesics after remifentanil-desflurane anesthesia in patients with thyroidectomy.


METHODS
Sixty two patients undergoing thyroidectomy under general anesthesia were randomly allocated into two groups. All patients were anesthetised with desflurane and high-dose remifentanil. Remifentnail was infused at the rate of 0.3 μg/kg/min until the end of surgery in patients of the control group (group A) whereas remifentanil was tapered gradually from 0.3 to 0.1 μg/kg/min until the end of surgery for at least 30 minutes in patients with group B. Pain scores (0-100 numerical rating scale, NRS), rescue analgesic requirements and adverse events were assessed at 30 min, 2 h, 6 h, 12 h, and 24 h after operation.


RESULTS
There was a significant decrease in pain scores at 30 min (20 [0-80] vs. 50 [0-100], P = 0.002) and 2 h (30 [10-60] vs. 40 [20-80], P = 0.018) after surgery in group B compared with group A. In addition, rescue analgesics are less required in group B than in group A postoperatively (2 [1-3] vs. 3 [2,3], P = 0.039). There were no significant differences in adverse events between the two groups.


CONCLUSIONS
Tapering of remifentanil at the end of surgery decreased postoperative pain scores immediately after thyroidectomy with desflurane and high-dose remifentanil anesthesia.


BACKGROUND
Clinical Research information Service (CRiS, registration number KCT0000589).
Department of Anesthesiology & Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea. hss9438@empal.com.
Sun Sook
SS
Han
Department of Anesthesiology & Pain Medicine, Seoul National University College of Medicine, Seoul, South Korea. shdo@snu.ac.kr.|Department of Anesthesiology & Pain Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea. shdo@snu.ac.kr.
Sang Hwan
SH
Do
Department of Anesthesiology & Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea. kserafina@naver.com.
Tae Hee
TH
Kim
Department of Anesthesiology & Pain Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea. eungmang@medigate.net.
Won Joon
WJ
Choi
Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea. yun@samsung.com.
Ji Sup
JS
Yun
Department of Anesthesiology & Pain Medicine, Seoul National University College of Medicine, Seoul, South Korea. jinaryu@lycos.co.kr.|Department of Anesthesiology & Pain Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea. jinaryu@lycos.co.kr.
Jung Hee
JH
Ryu
D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use*; D000762:Anesthesia Recovery Period; D019162:Anesthetics, Combined / Q000008:administration & dosage; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D000077335:Desflurane; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007530:Isoflurane / Q000008:administration & dosage / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D010880:Piperidines / Q000008:administration & dosage*; D011446:Prospective Studies; D000077208:Remifentanil; D016037:Single-Blind Method; D013964:Thyroid Neoplasms / Q000601:surgery; D016606:Thyroid Nodule / Q000601:surgery; D013965:Thyroidectomy / Q000379:methods; D055815:Young Adult
D000700:Analgesics; D019162:Anesthetics, Combined; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D010880:Piperidines; D000077335:Desflurane; D007530:Isoflurane; D000077208:Remifentanil