Presented at the 2013 AAPM Annual Meeting « Back

Antihyperalgesic Effects of Dexmedetomidine on High-Dose Remifentanil-Induced Hyperalgesia

Yeon-Dong Kim, MD, kydpain@hanmail.net¹, Cheol Lee, MD², (1) Wonkwang University Hospital, Iksan, North Jeolla, South Korea, (2) Wonkwang University College of Medicine, Sinyong-dong, Iksan, South Korea

Background: Dexmedetomidine is a highly selective a2 adrenergic agonist that has been shown to decrease the intensity of opioid-induced hyperalgesia (OIH). We aimed to investigate the antihyperalgesic effects of dexmedetomidine on high-dose remifentanil-induced hyperalgesia. Methods: Ninety patients undergoing laparoscopically assisted vaginal hysterectomy (LAVH) were randomly assigned to the following 3 groups, each of which received either dexmedetomidine (an initial dose of 1.0 µg/kg for 10 min, followed by a continuous infusion of 0.7 µg/kg/hr) or placebo saline 15 min before the induction of anesthesia and intraoperative remifentanil infusion: group C received placebo and 0.05 µg/kg/min remifentanil; group RH received placebo and 0.3 µg/kg/min remifentanil; and group DRH received dexmedetomidine and 0.3 µg/kg/min remifentanil. Results: Mechanical hyperalgesia threshold 24 h after surgery was significantly lower in group RH than in the other two groups. Postoperative pain intensity using visual analog scale (VAS) and cumulative volume of a patient-controlled analgesia (PCA) containing morphine over 24 h were significantly greater in group RH than in group DRH. The time to first postoperative analgesic requirement was significantly shorter in group RH than in the other two groups. The shivering and postoperative nausea and vomiting were significantly lower in group DRH than in the other two groups. Conclusions: High-dose remifentanil induced hyperalgesia, but dexmedetomidine efficiently alleviated those symptoms. Dexmedetomidine may be a novel and effective treatment option for OIH. References: 1) Belgrade M, Hall S. Dexmedetomidine infusion for the management of opioid-induced hyperalgesia. Pain Med 2010; 11: 1819-26. 2) Blaudszun G, Lysakowski C, Elia N, Tramèr MR. Effect of perioperative systemic a2 agonists on postoperative morphine consumption and pain intensity: systematic review and meta-analysis of randomized controlled trials. Anesthesiology 2012; 116: 1312-22.

Funding: None

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