Anesth Pain Med.  2024 Apr;19(2):117-124. 10.17085/apm.23146.

Relationship between intraoperative requirement for anesthetics and postoperative analgesic consumption in laparoscopic colectomy: a randomized controlled double-blinded study

• Lee JH
• Doo AR
• Oh H
• Lee H
• Ko S

• KMID: 2555248
• DOI: http://doi.org/10.17085/apm.23146

Abstract

Background
This study investigated the relationship between intraoperative requirement for an inhalational anesthetic (sevoflurane) or an opioid (remifentanil) and postoperative analgesic consumption.
Methods
The study included 200 adult patients undergoing elective laparoscopic colectomy. In the sevoflurane group, the effect-site concentration of remifentanil was fixed at 1.0 ng/ml, while the inspiratory sevoflurane concentration was adjusted to maintain an appropriate anesthetic depth. In the remifentanil group, the end-expiratory sevoflurane concentration was fixed at 1.0 volume%, and the remifentanil concentration was adjusted. Pain scores and cumulative postoperative analgesic consumptions were evaluated at 2, 6, 24, and 48 h after surgery.
Results
Average end-tidal concentration of sevoflurane and effect-site concentration of remifentanil were 2.0 ± 0.4 volume% and 3.9 ± 1.4 ng/ml in the sevoflurane and remifentanil groups, respectively. Cumulative postoperative analgesic consumption at 48 h postoperatively was 55 ± 26 ml in the sevoflurane group and 57 ± 33 ml in the remifentanil group. In the remifentanil group, the postoperative cumulative analgesic consumptions at 2 and 6 h were positively correlated with intraoperative remifentanil requirements (2 h: r = 0.36, P < 0.01; 6 h: r = 0.38, P < 0.01). However, there was no significant correlation in the sevoflurane group (r = 0.04, P = 0.69).
Conclusions
The amount of intraoperative requirement of short acting opioid, remifentanil, is correlated with postoperative analgesic consumption within postoperative 6 h. It may be contributed by the development of acute opioid tolerance. However, intraoperative sevoflurane requirement had no effect on postoperative analgesic consumption.

Keyword

Anesthesia; Anesthetics; Analgesia; Opioid; Remifentanil; Sevoflurane

Figure

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  Fig. 1. CONSORT flow diagram. CONSORT: consolidated standards of reporting trials, PCA: patients-controlled analgesia.

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  Fig. 2. Cumulative analgesic consumption at 48 h postoperatively had no significant correlation with intraoperative inhalational anesthetic, sevoflurane, requirement in the sevoflurane group (r = 0.04, P = 0.691, A). In addition, there were no significant correlations between postoperative 48 h cumulative analgesic consumption and intraoperative remifentanil requirement (r = 0.02, P = 0.823, B).

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  Fig. 3. The cumulative analgesic consumptions at 2 (r = 0.36, P < 0.001, A) and 6 h (r = 0.38, P < 0.001, B) postoperatively were significantly correlated with intraoperative remifentanil requirement in the remifentanil group.

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  Fig. 4. In the remifentanil group, the analgesic consumption within postoperative 2 h was significantly higher than in the sevoflurane group, but there was no difference after that time (*P < 0.001).

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  Fig. 5. There were no differences in MAP during surgery in both groups, but average HR was lower in the remifentanil group compared to sevoflurane group (*P < 0.001). MAP: mean arterial pressures, HR: heart rate, SI: skin incision, SC: skin closure.

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  Fig. 6. BIS value was higher in the remifentanil group than in the sevoflurane group (*P < 0.001). BIS: bispectral index, SI: skin incision, SC: skin closure.

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