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Modulation of remifentanil-induced postinfusion hyperalgesia by propofol
Boris Singler1, Andreas Tröster, Neil Manering
1Department of Anesthesiology, University Hospital Erlangen, Erlangen, Germany.
Anesthesia and Analgesia
|May 22, 2007
Summary
Propofol, at subhypnotic doses, reduced pain during remifentanil infusion. However, it only delayed and weakened, not fully prevented, opioid-induced hyperalgesia after the infusion ended.
Area of Science:
- Anesthesiology
- Pain Management
- Pharmacology
Background:
- Opioid exposure can increase pain sensitivity.
- Opioids are often combined with hypnotics during anesthesia.
- Investigating propofol's effects on opioid-induced hyperalgesia is crucial.
Purpose of the Study:
- To determine if subhypnotic propofol has analgesic or antihyperalgesic properties.
- To assess propofol's impact on remifentanil-induced hypersensitivity.
- To explore interactions between propofol and remifentanil in a human pain model.
Main Methods:
- A randomized, double-blind, placebo-controlled, cross-over study with 15 volunteers.
- High-current transcutaneous electrical stimulation induced acute pain and hyperalgesia.
- Pain and hyperalgesia were measured during and after infusions of propofol and remifentanil alone or in combination.
Main Results:
- Propofol (subhypnotic) reduced electrically evoked pain.
- Propofol did not cause hyperalgesia.
- Combined propofol and remifentanil showed synergistic analgesia, but withdrawal led to increased pain and hyperalgesia.
Conclusions:
- Propofol and remifentanil interact clinically, delaying and weakening opioid-induced postinfusion hyperalgesia.
- Propofol did not fully counteract pronociceptive effects.
- This interaction may explain increased analgesic needs post-remifentanil anesthesia.
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