Remifentanil and worse patient-reported outcomes regarding postoperative pain management after thyroidectomy

• Published in: Journal of clinical anesthesia 2016-06, Vol.31, p.27-33
• Main Authors: Sanfilippo, Filippo, Conticello, Caren, Santonocito, Cristina, Minardi, Carmelo, Palermo, Filippo, Bernardini, Renato, Gullo, Antonino, Astuto, Marinella
• Format: Article
• Language: English
• Subjects: Acute pain; Adult; Aged; Analgesic drugs; Analgesics; Analgesics, Opioid - administration & dosage; Anesthesia; Anesthesia & Perioperative Care; Anesthesia, Intravenous - adverse effects; Anesthesia, Intravenous - methods; Anesthetics, Intravenous - adverse effects; Data collection; Drug Administration Schedule; Drug dosages; Female; Humans; Hyperalgesia; Hyperalgesia - chemically induced; Intensive care; Male; Middle Aged; Narcotics; Opioid; Pain management; Pain Management - methods; Pain Medicine; Pain, Postoperative - etiology; Patient assessment; Patient outcome assessment; Patient Reported Outcome Measures; Patients; Piperidines - adverse effects; Postoperative period; Questionnaires; Studies; Thyroidectomy - adverse effects; Variables
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2015.12.025

Abstract Background Intraoperative remifentanil has been associated with postoperative hyperalgesia, higher visual analogic pain scores, and increased postoperative morphine consumption. However, this has not been investigated from patient’s perspective by using a patient-reported outcomes (PROs) approach with a validated questionnaire. Methods We joined the largest prospective observational study on postoperative pain, PAIN OUT Project (NCT02083835), and collected data for 2 years. We studied the effects of remifentanil (R +) vs nonremifentanil (R −) anesthesia on PROs regarding their pain management after elective thyroidectomy. We selected 5 primary PROs (worst pain experienced, time spent in severe pain, relief received by treatment, satisfaction about pain management, wish for more pain treatment) and five secondary PROs (drowsiness, itching, nausea, dizziness, waking up due to pain) from the validated International Pain Outcomes questionnaire. Results The analysis included 317 patients, 208 in the R + group (65.6%) and 109 in the R − group (34.4%), the latter receiving fentanyl as intraoperative opioid. Although the R + group received more frequently intraoperative nonopioids (202/208, 97.1% vs 86/109, 78.9%; P < .0001) and opioids (184/208, 88.5% vs 38/109, 34.9%; P < .001), it reported higher worst pain (5.1±2.1 vs 4.3±2.1, P < .005), lower satisfaction (7.4±2.0 vs 8.1±2.1, P < .001), and worse results in 4 secondary PROs. A sensitivity analysis performed matching 67 couples of patients yielded similar results in primary PROs. Conclusions Our study suggests that remifentanil-based anesthesia is associated with worse pain-related PROs in patients undergoing thyroidectomy despite more frequent intraoperative analgesic administration. This study adds further evidence to the growing literature about opioid- and remifentanil-induced hyperalgesia.