The influence of high-dose intraoperative remifentanil on postoperative sore throat: a prospective randomized study: A CONSORT compliant article

Ji-Hoon Park, Yong-Cheol Lee, Jiwon Lee, Hyunjae Kim, Hyun-Chang Kim, Ji-Hoon Park, Yong-Cheol Lee, Jiwon Lee, Hyunjae Kim, Hyun-Chang Kim

Abstract

Background: Endotracheal intubation for general anesthesia causes postoperative sore throat (POST). This study is designed to evaluate the effect of high-dose remifentanil on the incidence of POST in patients after general anesthesia.

Methods: Ninety-two patients scheduled for orthopedic lower extremity surgery under general anesthesia were randomly assigned into 1 of 2 groups. In the high-dose remifentanil (HR) group (n = 46), remifentanil was infused at a rate of 0.25 μg/kg/min and subsequently increased or decreased by 0.05 μg/kg/min per clinical demand. In the low-dose remifentanil (LR) group (n = 46), remifentanil was infused at a rate of 0.05 μg/kg/min. The incidence of POST was monitored at 0, 2, 4, and 24 hours postoperatively. Complications regarding opioids were compared between groups.

Results: The overall incidence of POST was higher in the HR group compared with that in the LR group [33 (72%) vs 18 (39%), P = .022]. The incidence of POST at 0, 2, and 24 hours after surgery was higher in the HR group compared with that in the LR group (P < .001, P = .001, and P = .001, respectively). The incidence of postoperative nausea, vomiting, drowsiness, and headache was similar between the groups. The incidence of postoperative shivering was higher in the HR group than in the LR group [10 (22%) vs 2 (4%), difference 17%, 95% CI 2%-33%, P = .027].

Conclusion: A relatively large dose of intraoperative remifentanil increased the incidence of POST in patients for orthopedic surgery under general anesthesia.

Trial registration: Clinicaltrials.gov Identifier: NCT03173339.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
CONSORT diagram for the investigation. Ninety-two patients were randomized and included into final analysis.
Figure 2
Figure 2
Percentage incidence and severity of postoperative sore throat. ∗P < .001 versus low-dose remifentanil group, †P < .05 versus low-dose remifentanil group. HR = high-dose remifentanil group, LR = low-dose remifentanil group.
Figure 3
Figure 3
Mean scores of numerical wound pain scores (0: no pain, 10: worst imaginable pain). Error bar shows 95% confidence interval for mean. HR = high-dose remifentanil group, LR = low-dose remifentanil group.

References

    1. Macario A, Weinger M, Carney S, et al. Which clinical anesthesia outcomes are important to avoid? The perspective of patients. Anesth Analg 1999;89:652–8.
    1. Park SH, Han SH, Do SH, et al. Prophylactic dexamethasone decreases the incidence of sore throat and hoarseness after tracheal extubation with a double-lumen endobronchial tube. Anesth Analg 2008;107:1814–8.
    1. Sumathi PA, Shenoy T, Ambareesha M, et al. Controlled comparison between betamethasone gel and lidocaine jelly applied over tracheal tube to reduce postoperative sore throat, cough, and hoarseness of voice. Br J Anaesth 2008;100:215–8.
    1. Maruyama K, Sakai H, Miyazawa H, et al. Sore throat and hoarseness after total intravenous anaesthesia. Br J Anaesth 2004;92:541–3.
    1. Yu EH, Tran DH, Lam SW, et al. Remifentanil tolerance and hyperalgesia: short-term gain, long-term pain? Anaesthesia 2016;71:1347–62.
    1. Angst MS. Intraoperative use of remifentanil for TIVA: postoperative pain, acute tolerance, and opioid-induced hyperalgesia. J Cardiothorac Vasc Anesth 2015;29suppl 1:S16–22.
    1. Mapleson WW. Effect of age on MAC in humans: a meta-analysis. Br J Anaesth 1996;76:179–85.
    1. Kim HC, Lee YH, Kim E, et al. Comparison of the endotracheal tube cuff pressure between a tapered- versus a cylindrical-shaped cuff after changing from the supine to the lateral flank position. Can J Anaesth 2015;62:1063–70.
    1. Huang YS, Hung NK, Lee MS, et al. The effectiveness of benzydamine hydrochloride spraying on the endotracheal tube cuff or oral mucosa for postoperative sore throat. Anesth Analg 2010;111:887–91.
    1. Latremoliere A, Woolf CJ. Central sensitization: a generator of pain hypersensitivity by central neural plasticity. J Pain 2009;10:895–926.
    1. Vanegas H, Schaible HG. Descending control of persistent pain: inhibitory or facilitatory? Brain Res Brain Res Rev 2004;46:295–309.
    1. McHardy FE, Chung F. Postoperative sore throat: cause, prevention and treatment. Anaesthesia 1999;54:444–53.
    1. Stout DM, Bishop MJ, Dwersteg JF, et al. Correlation of endotracheal tube size with sore throat and hoarseness following general anesthesia. Anesthesiology 1987;67:419–21.
    1. Stenqvist O, Nilsson K. Postoperative sore throat related to tracheal tube cuff design. Can Anaesth Soc J 1982;29:384–6.
    1. Estebe JP, Delahaye S, Le Corre P, et al. Alkalinization of intra-cuff lidocaine and use of gel lubrication protect against tracheal tube-induced emergence phenomena. Br J Anaesth 2004;92:361–6.
    1. Thomas S, Beevi S. Dexamethasone reduces the severity of postoperative sore throat. Can J Anaesth 2007;54:897–901.
    1. Higgins PP, Chung F, Mezei G. Postoperative sore throat after ambulatory surgery. Br J Anaesth 2002;88:582–4.
    1. Joo HS, Perks WJ, Belo SE. Sevoflurane with remifentanil allows rapid tracheal intubation without neuromuscular blocking agents. Can J Anaesth 2001;48:646–50.
    1. Guignard B, Bossard AE, Coste C, et al. Acute opioid tolerance: intraoperative remifentanil increases postoperative pain and morphine requirement. Anesthesiology 2000;93:409–17.
    1. Treskatsch S, Klambeck M, Mousa SA, et al. Influence of high-dose intraoperative remifentanil with or without amantadine on postoperative pain intensity and morphine consumption in major abdominal surgery patients: a randomised trial. Eur J Anaesthesiol 2014;31:41–9.
    1. Joly V, Richebe P, Guignard B, et al. Remifentanil-induced postoperative hyperalgesia and its prevention with small-dose ketamine. Anesthesiology 2005;103:147–55.
    1. Song JW, Lee YW, Yoon KB, et al. Magnesium sulfate prevents remifentanil-induced postoperative hyperalgesia in patients undergoing thyroidectomy. Anesth Analg 2011;113:390–7.
    1. Agarwal A, Nath SS, Goswami D, et al. An evaluation of the efficacy of aspirin and benzydamine hydrochloride gargle for attenuating postoperative sore throat: a prospective, randomized, single-blind study. Anesth Analg 2006;103:1001–3.
    1. Canbay O, Celebi N, Sahin A, et al. Ketamine gargle for attenuating postoperative sore throat. Br J Anaesth 2008;100:490–3.
    1. El-Boghdadly K, Bailey CR, Wiles MD. Postoperative sore throat: a systematic review. Anaesthesia 2016;71:706–17.
    1. Suzuki N, Kooguchi K, Mizobe T, et al. [Postoperative hoarseness and sore throat after tracheal intubation: effect of a low intracuff pressure of endotracheal tube and the usefulness of cuff pressure indicator]. Masui 1999;48:1091–5.
    1. Stanley TH, Kawamura R, Graves C. Effects of nitrous oxide on volume and pressure of endotracheal tube cuffs. Anesthesiology 1974;41:256–62.
    1. Thang’a P, Kamya D, Mung’ayi V. Effects of intravenous diclofenac on postoperative sore throat in patients undergoing laparoscopic surgery at Aga Khan University Hospital, Nairobi: a prospective, randomized, double blind controlled trial. Afr Health Sci 2013;13:999–1006.
    1. Rahimi M, Makarem J. Effects of diclofenac epolamine patch on postoperative sore throat in parturients after cesarean delivery under endotracheal general anesthesia. Acta Anaesthesiol Taiwan 2009;47:17–21.
    1. Nakasuji M, Nakamura M, Imanaka N, et al. Intraoperative high-dose remifentanil increases post-anaesthetic shivering. Br J Anaesth 2010;105:162–7.
    1. Eberhart LH, Doderlein F, Eisenhardt G, et al. Independent risk factors for postoperative shivering. Anesth Analg 2005;101:1849–57.
    1. Singh P, Dimitriou V, Mahajan RP, et al. Double-blind comparison between doxapram and pethidine in the treatment of postanaesthetic shivering. Br J Anaesth 1993;71:685–8.
    1. Aceto P, Dello Russo C, Lai C, et al. Relationship between blood remifentanil concentration and stress hormone levels during pneumoperitoneum in patients undergoing laparoscopic cholecystectomy. Eur Rev Med Pharmacol Sci 2017;21:4419–22.
    1. Park JH, Kim DH, Yoo SK, et al. The analgesic potency dose of remifentanil to minimise stress response induced by intubation and measurement uncertainty of surgical pleth index. Minerva Anestesiol 2018;84:546–55.

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