The Effects of Intraoperative Adenosine Infusion on Acute Opioid Tolerance and Opioid Induced Hyperalgesia Induced by Remifentanil in Adult Patients Undergoing Tonsillectomy
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Background:Adenosine has been shown to have a wide spectrum of unique pain-relieving effects in various clinical situations. The aim of this study was to investigate the effects of intraoperative adenosine infusion on acute opioid tolerance and opioid induced hyperalgesia induced by remifentanil in adult patients undergoing tonsillectomy. Methods:For this study, ninety patients were randomly allocated into groups that receive either adenosine (adenosine group) or saline (remifentnail group) intravenously under remifentanil based anesthesia and saline (sevoflurane group) under sevoflurane anesthesia. The patients in adenosine group received adenosine at dose of 80 mg/kg/min, and those in remifentnail group and sevoflurane group received an equal volume of saline 10 minutes after the induction of anesthesia until the end of surgery. Intraoperative evaluation included time weighted mean remifentanil dose, and postoperative evaluations included degree of pain severity at 1, 6, 12, and 24 hours, time to first postoperative requirement, and analgesic dose required during 24 hours after operation. Results:Time weighted mean remifentanil dose during intraoperative period in adenosine group was significantly lower than that of remifentnail group (P = 0.00). The first postoperative analgesic were required earlier in remifentanil group than sevoflurane group or adenosine group (P = 0.00). Pethidine requirement during 24 hours in sevoflurane group and adenosine group was significantly lower than that of remifentnail group (P = 0.00). The visual analog scale scores for pain in sevoflurane group and adenosine group were significantly lower than those of remifentnail group for 12 hours after operation (P = 0.00). Incidence of hypotension (P = 0.024) and number of ephedrine administered (P = 0.011) in adenosine group were significantly higher than those of sevoflurane group. Conclusions:The above results suggest that intraoperative adenosine infusion prevent acute opioid tolerance and opioid induced hyperalgesia induced by remifentanil.
Abstract
Background:Adenosine has been shown to have a wide spectrum of unique pain-relieving effects in various clinical situations. The aim of this study was to investigate the effects of intraoperative adenosine infusion on acute opioid tolerance and opioid induced hyperalgesia induced by remifentanil in adult patients undergoing tonsillectomy. Methods:For this study, ninety patients were randomly allocated into groups that receive either adenosine (adenosine group) or saline (remifentnail group) intravenously under remifentanil based anesthesia and saline (sevoflurane group) under sevoflurane anesthesia. The patients in adenosine group received adenosine at dose of 80 mg/kg/min, and those in remifentnail group and sevoflurane group received an equal volume of saline 10 minutes after the induction of anesthesia until the end of surgery. Intraoperative evaluation included time weighted mean remifentanil dose, and postoperative evaluations included degree of pain severity at 1, 6, 12, and 24 hours, time to first postoperative requirement, and analgesic dose required during 24 hours after operation. Results:Time weighted mean remifentanil dose during intraoperative period in adenosine group was significantly lower than that of remifentnail group (P = 0.00). The first postoperative analgesic were required earlier in remifentanil group than sevoflurane group or adenosine group (P = 0.00). Pethidine requirement during 24 hours in sevoflurane group and adenosine group was significantly lower than that of remifentnail group (P = 0.00). The visual analog scale scores for pain in sevoflurane group and adenosine group were significantly lower than those of remifentnail group for 12 hours after operation (P = 0.00). Incidence of hypotension (P = 0.024) and number of ephedrine administered (P = 0.011) in adenosine group were significantly higher than those of sevoflurane group. Conclusions:The above results suggest that intraoperative adenosine infusion prevent acute opioid tolerance and opioid induced hyperalgesia induced by remifentanil.
참고문헌 (20)
- Sawynok J, "Adenosine receptor activation and nociception", Eur J Pharmacol, 347, pp.1~11 (1998)
- Sollevi A, "Adenosine for pain control", Acta Anaesthesiol Scand Suppl, 110, pp.135~136 (1997)
- Gan TJ, "Adenosine as a non-opioid analgesic in the perioperative setting", Anesth Analg, 105, pp.487~494 (2007)
- Segerdahl M, "Peroperative adenosine infusion reduces the requirements for isoflurane and postoperative analgesics", Anesth Analg, 80, pp.1145~1149 (1995)
- Segerdahl M, "Peroperative adenosine infusion reduces isoflurane concentrations during general anesthesia for shoulder surgery", Acta Anaesthesiol Scand, 40, pp.792~797 (1996)
- Segerdahl M, "Antinociceptive effect of perioperative adenosine infusion in abdominal hysterectomy", Acta Anaesthesiol Scand, 41, pp.473~479 (1997)
- Thompson JP, "Remifentanil--an opioid for the 21st century", Br J Anaesth, 76, pp.341~343 (1996)
- Fletcher D, "The efficacy of intravenous 0.15 versus 0.25 mg", kg intraoperative morphine for immediate postoperative analgesia after remifentanil-based anesthesia for major surgery, 2000, pp.90, 666~671
- Fukunaga AF, "Characterization of the analgesic actions of adenosine: comparison of adenosine and remifentanil infusions in patients undergoing major surgical procedures", Pain, 101, pp.129~138 (2003)
- Hayashida M, "Clinical application of adenosine and ATP for pain control", J Anesth, 19, pp.225~235 (2005)
- Seitz PA, "Adenosine decreases the minimum alveolar concentration of halothane in dogs", Anesthesiology, 73, pp.990~994 (1990)
- Cronstein BN, "Adenosine, an endogenous anti-inflammatory agent", J Appl Physiol, 76, pp.5~13 (1994)
- Montesinos MC, "Adenosine A2A or A3 receptors are required for inhibition of inflammation by methotrexate and its analog MX-68", Arthritis Rheum, 48, pp.240~247 (2003)
- Rane K, "Intrathecal adenosine administration in abdominal hysterectomy lacks analgesic effect", Acta Anaesthesiol Scand, 44, pp.868~872 (2000)
- Rane K, "A randomised double-blind evaluation of adenosine as adjunct to sufentanil in spinal labour analgesia", Acta Anaesthesiol Scand, 47, pp.601~603 (2003)
- Seymour RA, "The efficacy of a novel adenosine agonist (WAG 994) in postoperative dental pain", Br J Clin Pharmacol, 47, pp.675~680 (1999)
- Angst MS, "Opioid-induced hyperalgesia: a qualitative systematic review", Anesthesiology, 104, pp.570~587 (2006)
- Yaksh TL, "High dose of spinal morphine produce a nonopiate receptor-mediated hyperesthesia: clinical and theoretic implications", Anesthesiology, 64, pp.590~597 (1986)
- Van Elstraete AC, "Protective effect of prior administration of magnesium on delayed hyperalgesia induced by fentanyl in rats", Can J Anaesth, 53, pp.1180~1185 (2006)
- Nörenberg W, "Adenosine A2A receptors inhibit the conductance of NMDA receptor channels in rat neostriatal neurons", Amino Acids, 14, pp.33~39 (1998)