Background. Postoperative secondary hyperalgesia arises from central sensitization due to pain pathways facilitation and/ or acute opioid exposure. The latter is also known as opioid-induced hyperalgesia (OIH). Remifentanil, a potent l-opioid agonist, reportedly induces postoperative hyperalgesia and increases postoperative pain scores and opioid consumption. The pathophysiology underlying secondary hyperalgesia involves N-methyl-D-aspartate (NMDA)-mediated pain pathways. In this study, we investigated whether perioperatively infusing low-dose buprenorphine, an opioid with anti-NMDA activity, in patients receiving remifentanil infusion prevents postoperative secondary hyperalgesia. Methods. Sixty-four patients, undergoing remifentanil infusion during general anaesthesia andmajor lung surgery, were randomly assigned to receive either buprenorphine i.v. infusion (25lg h1 for 24h) ormorphine (equianalgesic dose) perioperatively. The presence and extent of punctuate hyperalgesia were assessed one day postoperatively. Secondary outcome variables included postoperative pain scores, opioid consumption and postoperative neuropathic pain assessed one and threemonths postoperatively. Results. A distinct area of hyperalgesia or allodynia around the surgical incision was found in more patients in the control group than in the treated group. Mean time from extubation to first morphine rescue dose was twice as long in the buprenorphine-treated group than in the morphine-treated group: 18 vs 9min (P¼0.002). At 30min postoperatively, patients receiving morphine had a higher hazard ratio for the first analgesic rescue dose than those treated with buprenorphine (P¼0.009). At three months, no differences between groups were noted. Conclusions. Low-dose buprenorphine infusion prevents the development of secondary hyperalgesia around the surgical incision but shows no long-term efficacy at three months follow-up.

Low-dose buprenorphine infusion to prevent postoperative hyperalgesia in patients undergoing major lung surgery and remifentanil infusion. a double-blind, randomized, active-controlled trial / Mercieri, Marco; Palmisani, Stefano; DE BLASI, Roberto Alberto; D'Andrilli, ANTONIO LUCIO; Naccarato, Alessia; Silvestri, Barbara; Tigano, Sara; Massullo, Domenico; Rocco, Monica; Arcioni, Roberto. - In: BRITISH JOURNAL OF ANAESTHESIA. - ISSN 0007-0912. - STAMPA. - 119:4(2017), pp. 792-802. [10.1093/bja/aex174]

Low-dose buprenorphine infusion to prevent postoperative hyperalgesia in patients undergoing major lung surgery and remifentanil infusion. a double-blind, randomized, active-controlled trial

MERCIERI, MARCO;PALMISANI, STEFANO;DE BLASI, Roberto Alberto;D'ANDRILLI, ANTONIO LUCIO;NACCARATO, ALESSIA;SILVESTRI, BARBARA;TIGANO, SARA;MASSULLO, Domenico;ROCCO, Monica;ARCIONI, Roberto
2017

Abstract

Background. Postoperative secondary hyperalgesia arises from central sensitization due to pain pathways facilitation and/ or acute opioid exposure. The latter is also known as opioid-induced hyperalgesia (OIH). Remifentanil, a potent l-opioid agonist, reportedly induces postoperative hyperalgesia and increases postoperative pain scores and opioid consumption. The pathophysiology underlying secondary hyperalgesia involves N-methyl-D-aspartate (NMDA)-mediated pain pathways. In this study, we investigated whether perioperatively infusing low-dose buprenorphine, an opioid with anti-NMDA activity, in patients receiving remifentanil infusion prevents postoperative secondary hyperalgesia. Methods. Sixty-four patients, undergoing remifentanil infusion during general anaesthesia andmajor lung surgery, were randomly assigned to receive either buprenorphine i.v. infusion (25lg h1 for 24h) ormorphine (equianalgesic dose) perioperatively. The presence and extent of punctuate hyperalgesia were assessed one day postoperatively. Secondary outcome variables included postoperative pain scores, opioid consumption and postoperative neuropathic pain assessed one and threemonths postoperatively. Results. A distinct area of hyperalgesia or allodynia around the surgical incision was found in more patients in the control group than in the treated group. Mean time from extubation to first morphine rescue dose was twice as long in the buprenorphine-treated group than in the morphine-treated group: 18 vs 9min (P¼0.002). At 30min postoperatively, patients receiving morphine had a higher hazard ratio for the first analgesic rescue dose than those treated with buprenorphine (P¼0.009). At three months, no differences between groups were noted. Conclusions. Low-dose buprenorphine infusion prevents the development of secondary hyperalgesia around the surgical incision but shows no long-term efficacy at three months follow-up.
File allegati a questo prodotto
File Dimensione Formato  
Mercieri_Low-dose_2017.pdf

accesso aperto

Note: Articolo originale
Tipologia: Documento in Post-print (versione successiva alla peer review e accettata per la pubblicazione)
Licenza: Tutti i diritti riservati (All rights reserved)
Dimensione 553.39 kB
Formato Adobe PDF
553.39 kB Adobe PDF Visualizza/Apri PDF

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1007146
Citazioni
  • ???jsp.display-item.citation.pmc??? 8
  • Scopus 21
  • ???jsp.display-item.citation.isi??? 17
social impact