• Jean-Corentin Salengros, Isabelle Huybrechts, Anne Ducart, David Faraoni, Corinne Marsala, Luc Barvais, Matteo Cappello, and Edgard Engelman.
• Department of Anesthesiology, Erasme University Hospital, Brussels, Belgium.
• J. Cardiothorac. Vasc. Anesth. 2010 Aug 1;24(4):608-16.

ObjectiveTo investigate the relationships between 2 anesthetic techniques, or the extent of allodynia around the surgical wound, and the occurrence of chronic post-thoracotomy pain.DesignProspective, randomized study.SettingA single-institution, university hospital.ParticipantsThirty-eight patients who underwent elective thoracotomy under general anesthesia.InterventionsHigh-dose remifentanil (average effect-site concentration 5.61 +/- 0.84 ng/mL) with epidural analgesia started and at the end of surgery or low-dose remifentanil (average effect site concentration 1.99 +/- 0.02 ng/mL) with epidural analgesia with 0.5% ropivacaine started at the beginning of anesthesia.Measurements And Main ResultsPain intensity and the extent of allodynia around the wound were measured during the hospital stay. The presence and intensity of residual pain were assessed 1, 3, and 6 months after surgery and at the end of the study (6-13 months, average 9 months). A DN4 neuropathic pain diagnostic questionnaire was conducted at the same times. In the high-dose group, the area with allodynia was three times larger than the area in the low-dose group. The increased allodynia was associated with a higher incidence of chronic pain (RR: 2.7-4.2) 3 and 6 months after surgery and at the end of the study (median follow-up: 9.5 months).ConclusionsHigh-dose remifentanil (0.14-0.26 microg/kg/min) without epidural analgesia during surgery is associated with a large area of allodynia around the wound. These patients develop a much higher incidence of chronic pain than those receiving low-dose remifentanil with epidural analgesia during surgery.Copyright 2010 Elsevier Inc. All rights reserved.

This article appears in the collection: Is remifentanil associated with Opioid Induced Hyperalgesia and Acute Opioid Tolerance?.

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