title: Influence of high-dose intraoperative remifentanil with intravenous ibuprofen on postoperative morphine consumption in patients undergoing pancreaticoduodenectomy: a randomized trial.
abstract: OBJECTIVE
  High-dose remifentanil during surgery paradoxically increases postoperative pain intensity and morphine consumption. Cyclooxygenase inhibitors decrease prostaglandin synthesis, thereby antagonizing N-methyl-d-aspartate receptor activation, and may reduce hyperalgesia. This study was performed to evaluate whether postoperative morphine consumption increased following intraoperative continuous remifentanil infusion and whether this could be prevented by intravenous ibuprofen pretreatment.
  
  
  METHODS
  A randomized controlled study.
  
  
  METHODS
  Single university hospital, study period from September 2014 to March 2015.
  
  
  METHODS
  One hundred and twenty patients undergoing pancreaticoduodenectomy.
  
  
  METHODS
  After induction of anesthesia, patients received remifentanil target-controlled infusion (effect site concentration of 4 ng/mL or 1 ng/mL) with or without intravenous ibuprofen (800 mg).
  
  
  METHODS
  Postoperative cumulative total morphine consumption and pain intensity were assessed.
  
  
  RESULTS
  Intraoperative remifentanil use in patients receiving high-dose remifentanil was more than 3-fold higher than that in patients receiving low-dose remifentanil (2666.8 ± 858.4 vs 872.0 ± 233.3 μg, respectively; P< .001). However, cumulative total morphine consumption at postoperative 1, 3, 6, 12, 24, and 48 hours did not differ among the groups. There were no differences among the groups in the self-administered analgesic dose by the patients using a controlled analgesia device, number of self-administration attempts, numerical rating scale for pain, or analgesic side effects.
  
  
  CONCLUSIONS
  We found no influence on postoperative pain after high-dose remifentanil in patients undergoing pancreaticoduodenectomy. Addition of intravenous ibuprofen did not reduce postoperative morphine consumption or pain intensity.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Chang-Hoon
authors.initials: CH
authors.lastname: Koo
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Youn Joung
authors.initials: YJ
authors.lastname: Cho
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Deok Man
authors.initials: DM
authors.lastname: Hong
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Yunseok
authors.initials: Y
authors.lastname: Jeon
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea. Electronic address: ktkktk@gmail.com.
authors.forename: Tae Kyong
authors.initials: TK
authors.lastname: Kim
mesh_terms: D000368:Aged; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D016861:Cyclooxygenase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006930:Hyperalgesia / Q000139:chemically induced / Q000628:therapy*; D007052:Ibuprofen / Q000008:administration & dosage / Q000627:therapeutic use*; D007262:Infusions, Intravenous / Q000009:adverse effects / Q000379:methods; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D010147:Pain Measurement; D010149:Postoperative Pain / Q000139:chemically induced / Q000628:therapy*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D010880:Piperidines / Q000008:administration & dosage / Q000009:adverse effects*; D011184:Postoperative Period; D016194:Receptors, N-Methyl-D-Aspartate / Q000037:antagonists & inhibitors; D000077208:Remifentanil
chemical_list: D000701:Analgesics, Opioid; D016861:Cyclooxygenase Inhibitors; D010880:Piperidines; D016194:Receptors, N-Methyl-D-Aspartate; D009020:Morphine; D000077208:Remifentanil; D007052:Ibuprofen
keywords: Analgesic; Hyperalgeisa; Ibuprofen; Opioid