title: Remifentanil and worse patient-reported outcomes regarding postoperative pain management after thyroidectomy.
abstract: BACKGROUND
  Intraoperative remifentanil has been associated with postoperative hyperalgesia, higher visual analogic pain scores, and increased postoperative morphine consumption. However, this has not been investigated from patient's perspective by using a patient-reported outcomes (PROs) approach with a validated questionnaire.
  
  
  METHODS
  We joined the largest prospective observational study on postoperative pain, PAIN OUT Project (NCT02083835), and collected data for 2 years. We studied the effects of remifentanil (R+) vs nonremifentanil (R-) anesthesia on PROs regarding their pain management after elective thyroidectomy. We selected 5 primary PROs (worst pain experienced, time spent in severe pain, relief received by treatment, satisfaction about pain management, wish for more pain treatment) and five secondary PROs (drowsiness, itching, nausea, dizziness, waking up due to pain) from the validated International Pain Outcomes questionnaire.
  
  
  RESULTS
  The analysis included 317 patients, 208 in the R+ group (65.6%) and 109 in the R- group (34.4%), the latter receiving fentanyl as intraoperative opioid. Although the R+ group received more frequently intraoperative nonopioids (202/208, 97.1% vs 86/109, 78.9%; P < .0001) and opioids (184/208, 88.5% vs 38/109, 34.9%; P < .001), it reported higher worst pain (5.1±2.1 vs 4.3±2.1, P < .005), lower satisfaction (7.4±2.0 vs 8.1±2.1, P < .001), and worse results in 4 secondary PROs. A sensitivity analysis performed matching 67 couples of patients yielded similar results in primary PROs.
  
  
  CONCLUSIONS
  Our study suggests that remifentanil-based anesthesia is associated with worse pain-related PROs in patients undergoing thyroidectomy despite more frequent intraoperative analgesic administration. This study adds further evidence to the growing literature about opioid- and remifentanil-induced hyperalgesia.
authors.affiliation: Department of Anesthesia and Intensive Care, School of Anesthesia and Intensive Care, University of Catania, 95100 Catania, Italy; Cardiothoracic Intensive Care Unit, Intensive Care Directorate-St George's Hospital, SW17 0QT London, United Kingdom. Electronic address: filipposanfi@yahoo.it.
authors.forename: Filippo
authors.initials: F
authors.lastname: Sanfilippo
authors.affiliation: Department of Anesthesia and Intensive Care, School of Anesthesia and Intensive Care, University of Catania, 95100 Catania, Italy.
authors.forename: Caren
authors.initials: C
authors.lastname: Conticello
authors.affiliation: Department of Anesthesia and Intensive Care, School of Anesthesia and Intensive Care, University of Catania, 95100 Catania, Italy; Department of Cardiac Intensive Care and Anesthesia, Morgagni Heart Centre, 95030 Pedara (CT), Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Santonocito
authors.affiliation: Department of Anesthesia and Intensive Care, School of Anesthesia and Intensive Care, University of Catania, 95100 Catania, Italy.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Minardi
authors.affiliation: Department of Anesthesia and Intensive Care, School of Anesthesia and Intensive Care, University of Catania, 95100 Catania, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Palermo
authors.affiliation: Department of Clinical and Molecular Biomedicine, University of Catania Medical School, 95100 Catania, Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: Bernardini
authors.affiliation: Department of Anesthesia and Intensive Care, School of Anesthesia and Intensive Care, University of Catania, 95100 Catania, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Gullo
authors.affiliation: Department of Anesthesia and Intensive Care, School of Anesthesia and Intensive Care, University of Catania, 95100 Catania, Italy.
authors.forename: Marinella
authors.initials: M
authors.lastname: Astuto
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000771:Anesthesia, Intravenous / Q000009:adverse effects / Q000379:methods; D018686:Anesthetics, Intravenous / Q000009:adverse effects*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D006930:Hyperalgesia / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods; D010149:Postoperative Pain / Q000209:etiology*; D000071066:Patient Reported Outcome Measures; D010880:Piperidines / Q000009:adverse effects*; D000077208:Remifentanil; D013965:Thyroidectomy / Q000009:adverse effects*
chemical_list: D000701:Analgesics, Opioid; D018686:Anesthetics, Intravenous; D010880:Piperidines; D000077208:Remifentanil
keywords: Acute pain; Analgesic drugs; Hyperalgesia; Opioid; Patient outcome assessment