Effects of different anesthetics on remifentanil-induced postinfusion hyperalgesia in patients undergoing percutaneous endoscopic interlaminar discectomy: a randomized controlled trial.

BACKGROUND

Continuous infusion of remifentanil during anesthesia potentially leads to remifentanil-induced postinfusion hyperalgesia (RPH), which may be regulated by anesthesia maintenance drugs. In this study, we investigated the effects of different anesthetics (remimazolam, propofol or sevoflurane) on RPH.

METHODS

One hundred and eleven patients who underwent percutaneous endoscopic interlaminar discectomy (PEID) under remifentanil-based anesthesia were randomized to one of three groups as follows: anesthesia maintenance with remimazolam (Group R), propofol (Group P) or sevoflurane (Group S). The mechanical pain thresholds of the forearm and incision area were measured using Von Frey filaments preoperatively and 24 h after surgery. Pain intensity, sufentanil consumption, side effects, and comfort and satisfaction were recorded for 24 h after surgery.

RESULTS

At 24 h after surgery, the mechanical pain thresholds around the skin incision were significantly greater in Group R [77.6 (19.7) vs. 63.7 (11.0) g, P < 0.001] and Group P [73.9 (15.4) vs. 63.7 (11.0) g, P = 0.019] than in Group S. Compared with Group S, Group R [3.9 (0.9) vs. 3.4 (0.7), P = 0.005] and Group P [4.2 (0.5) vs. 3.4 (0.7), P = 0.001] had significantly greater postoperative comfort and satisfaction at 24 h after surgery. The mechanical pain thresholds for the dominant inner forearm, postoperative pain intensity, sufentanil consumption, and side effects were similar among the three groups.

CONCLUSION

Continuous infusion of Propofol or remimazolam attenuated RPH but not acute pain or analgesic consumption after PEID, potentially lowering the risk of chronic pain.