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 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 2 January 2020 -- Source: Scopus |
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