202406202128

Status:

Tags:pharmacology

Remifentanil

opioid

Remifentanil induced hyperalgesia

• = opioid#OIH ?
• research complicated by pharmacokinetics
  • rapid clearance → ↓ effect quickly → ↑ pain abruptly
    • can be misinterpreted as RIH
  • remi often used in dose higher than required
    • for its synergistic effect w/ volatile anaesthetics & Propofol
    • → ↑ opioid exposure
  • most trials not distinguishing btw OIH vs acute tolerance vs opioid withdrawal-associated pain sensitivity
• ↑ RIH w/ ↑ remi dose i.e. dose dependent
  • 0.05 µg/kg/min should be safe
  • hyperalgesia induced at:
    • continuous infusion: ~0.1 µg/kg/mn
    • TCI : >= 2.7ng/ml
  • ↑ risk if:
    • cumulative dose >50 µg/kg
    • infusion rate >0.3 µg/kg/min

References

Remifentanil-Induced Hyperalgesia The Current State of Affairs