Impact of intraoperative remifentanil on postoperative pain and opioid use in thyroid surgery.

Abstract:

BACKGROUND AND OBJECTIVES:Remifentanil infusion is used as an intraoperative anesthetic for thyroidectomy, but has been associated with acute opioid tolerance and hyperalgesia. A national shortage of remifentanil provided an opportunity to study postoperative pain in patients undergoing thyroidectomy. METHODS:Retrospective review of prospectively collected data from an outpatient surgery center. Primary analysis compared patients treated before and after remifentanil shortage. RESULTS:Median postoperative opioid consumption was 20 morphine milligram equivalents (MMEs) among those treated in the high-dose period and 15 MMEs in the low-dose period. Remifentanil/weight received was a significant predictor of requiring a postoperative narcotic (P = .006). Total non-remifentanil narcotics administered were equivalent but patients in the low dose period received higher amounts of intraoperative long-acting narcotics. CONCLUSIONS:Remifentanil infusion for thyroid surgery is associated with higher postoperative pain and postoperative narcotics requirement. While a hyperalgesia state is possible, shifting of longer-acting narcotics from intraoperative to postoperatively is also supported.

journal_name

J Surg Oncol

authors

Wu JX,Assel M,Vickers A,Afonso AM,Twersky RS,Simon BA,Cohen MA,Rieth EF,Cracchiolo JR

doi

10.1002/jso.25746

subject

Has Abstract

pub_date

2019-12-01 00:00:00

pages

1456-1461

issue

8

eissn

0022-4790

issn

1096-9098

journal_volume

120

pub_type

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