• Br J Anaesth · Nov 2010

    Randomized Controlled Trial Comparative Study

    Maintenance anaesthetics during remifentanil-based anaesthesia might affect postoperative pain control after breast cancer surgery.

    • S-W Shin, A-R Cho, H-J Lee, H-J Kim, G J Byeon, J-W Yoon, K-H Kim, and J-Y Kwon.
    • Department of Anesthesia and Pain Medicine and Medical Research Institute, School of Medicine, Pusan National University, Beomeo-Ri, Mulgeum-Eup, Yangsan-Si, Gyeongsangnam-Do 626-770, Republic of Korea.
    • Br J Anaesth. 2010 Nov 1; 105 (5): 661-7.

    BackgroundAlthough remifentanil provides profound analgesia during operation, postoperative occurrence of hyperalgesia and tolerance after remifentanil administration could be a challenge to the postoperative pain control. In this investigation, we sought to determine the effect of maintenance with propofol or sevoflurane on postoperative analgesia after remifentanil-based anaesthesia.MethodsTwo hundred and fourteen women undergoing breast cancer surgery under remifentanil-based general anaesthesia were randomly included in this prospective and double-blind trial. The patients were anaesthetized with sevoflurane (S) or propofol (P) under high (H) or low (L) effect-site concentration (Ce) of remifentanil-based anaesthesia using a target-controlled infusion system; the patients were allocated into the SH, SL, PH, and PL groups. Pain intensity (visual analogue score, VAS) and cumulative morphine requirements were recorded 30 min, 1, 6, 12, and 24 h after operation.ResultsThe patient characteristics were similar. Cumulative morphine consumption at 24 h after surgery was higher in the SH group [38.6 (sd 14.9)] compared with the SL [31.5 (3.7)], PH [31.7 (8.3)], and PL groups [30.1 (6.1)] (P<0.001). The VAS scores during 24 h after surgery were also higher in the SH group than the SL, PH, and PL groups (P<0.001).ConclusionsRemifentanil hyperalgesia was induced by high dose of remifentanil-based anaesthesia during sevoflurane anaesthesia, whereas that was not apparent during propofol anaesthesia. Also, remifentanil hyperalgesia did not occur during low dose of remifentanil-based anaesthesia. Maintenance of propofol during high-dose remifentanil-based anaesthesia provided better postoperative analgesia.

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