Intraoperative infusion of 0.6-0.9 µg·kg(-1)·min(-1) remifentanil induces acute tolerance in young children after laparoscopic ureteroneocystostomy.

Abstract

BACKGROUND:

Intraoperative infusion of opioids has been associated with increased postoperative pain and analgesic requirements, but the development of tolerance in young children is less clear. This prospective, randomized, double-blinded study was designed to test the hypothesis that the intraoperative administration of remifentanil results in postoperative opioid tolerance in a dose-related manner in young children.

METHODS:

We enrolled 60 children (aged 1-5 yr) who were undergoing elective laparoscopic ureteroneocystostomy. Patients were randomized and received an intraoperative infusion of 0, 0.3, 0.6, or 0.9 µg·kg·min remifentanil. Postoperative pain was managed by a parent/nurse-controlled analgesia pump using fentanyl. The primary outcome included the total fentanyl consumptions at 24 and 48 h postsurgery. Secondary outcomes were the postoperative pain scores and adverse effects.

RESULTS:

The children who received 0.6 and 0.9 µg·kg·min remifentanil required more postoperative fentanyl than the children who received saline or 0.3 µg·kg·min remifentanil (all P < 0.001) for 24 h after surgery. The children who received 0.3-0.9 µg·kg·min intraoperative remifentanil reported higher pain scores at 1 h after surgery than the children who received saline (P = 0.002, P = 0.023, and P = 0.006, respectively). No significant intergroup differences in recovery variables were observed, but vomiting was more frequent in the 0.9 µg·kg·min remifentanil group than in the other groups (P = 0.027).

CONCLUSIONS:

The intraoperative use of 0.3 µg·kg·min remifentanil for approximately 3 h (range: 140-265 min) did not induce acute tolerance, but the administration of 0.6 and 0.9 µg·kg·min remifentanil to young children resulted in acute tolerance for 24 h after surgery in an apparently dose-related manner.

• Authors: Sung-Hoon Kim, Min H Lee, Hyungseok Seo, In-Gyu Lee, Jeong-Yeon Hong, Jai-Hyun Hwang
• Journal: Anesthesiology (Anesthesiology) Vol. 118 Issue 2 Pg. 337-43 (Feb 2013) ISSN: 1528-1175 [Electronic] United States
• PMID: 23241726 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• Analgesics, Opioid
• Piperidines
• Remifentanil

Topics

• Analgesia (methods)
• Analgesics, Opioid (administration & dosage, adverse effects, therapeutic use)
• Blood Pressure (drug effects)
• Child, Preschool
• Cystostomy
• Dose-Response Relationship, Drug
• Double-Blind Method
• Drug Tolerance
• Female
• Heart Rate (drug effects)
• Humans
• Infant
• Infusion Pumps
• Infusions, Intravenous
• Intraoperative Period
• Laparoscopy
• Male
• Piperidines (administration & dosage, adverse effects, therapeutic use)
• Postoperative Complications (epidemiology)
• Prospective Studies
• Remifentanil
• Sample Size