Impact of intraoperative remifentanil on postoperative pain and opioid use in thyroid surgery Journal Article

Authors: Wu, J. X.; Assel, M.; Vickers, A.; Afonso, A. M.; Twersky, R. S.; Simon, B. A.; Cohen, M. A.; Rieth, E. F.; Cracchiolo, J. R.
Article Title: Impact of intraoperative remifentanil on postoperative pain and opioid use in thyroid surgery
Abstract: Background and Objectives: Remifentanil infusion is used as an intraoperative anesthetic for thyroidectomy, but has been associated with acute opioid tolerance and hyperalgesia. A national shortage of remifentanil provided an opportunity to study postoperative pain in patients undergoing thyroidectomy. Methods: Retrospective review of prospectively collected data from an outpatient surgery center. Primary analysis compared patients treated before and after remifentanil shortage. Results: Median postoperative opioid consumption was 20 morphine milligram equivalents (MMEs) among those treated in the high-dose period and 15 MMEs in the low-dose period. Remifentanil/weight received was a significant predictor of requiring a postoperative narcotic (P =.006). Total non-remifentanil narcotics administered were equivalent but patients in the low dose period received higher amounts of intraoperative long-acting narcotics. Conclusions: Remifentanil infusion for thyroid surgery is associated with higher postoperative pain and postoperative narcotics requirement. While a hyperalgesia state is possible, shifting of longer-acting narcotics from intraoperative to postoperatively is also supported. © 2019 Wiley Periodicals, Inc.
Keywords: adult; controlled study; middle aged; retrospective studies; major clinical study; postoperative period; drug megadose; analysis; intraoperative care; low drug dose; medical record review; retrospective study; narcotic analgesic agent; paracetamol; thyroidectomy; hospital discharge; patient discharge; analgesics, opioid; pain measurement; drug utilization; analgesia; postoperative pain; infusions, intravenous; pain, postoperative; lobectomy; infusion; peroperative care; hyperalgesia; intravenous drug administration; pain management; thyroid surgery; postoperative analgesia; weight; remifentanil; long acting drug; ambulatory surgery; ambulatory surgical procedures; endocrine surgery; humans; human; male; female; priority journal; article; opioid use
Journal Title: Journal of Surgical Oncology
Volume: 120
Issue: 8
ISSN: 0022-4790
Publisher: Wiley Blackwell  
Date Published: 2019-12-15
Start Page: 1456
End Page: 1461
Language: English
DOI: 10.1002/jso.25746
PUBMED: 31680250
PROVIDER: scopus
PMCID: PMC6991192
Notes: Article -- Export Date: 2 January 2020 -- Source: Scopus
Citation Impact
MSK Authors
  1. Andrew J Vickers
    616 Vickers
  2. Melissa Jean Assel
    58 Assel
  3. Anoushka Maria Afonso
    14 Afonso
  4. Rebecca Shoshana Twersky
    14 Twersky
  5. Marc A Cohen
    35 Cohen
  6. Elizabeth Fay Rieth
    6 Rieth
  7. Brett Andrew Simon
    20 Simon
  8. James Wu
    6 Wu