Effect of Remimazolam on Pain Perception and Opioid-Induced Hyperalgesia in Patients Undergoing Laparoscopic Urologic Surgery—A Prospective, Randomized, Controlled Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Participants
- Patients aged 20 to 65 years;
- Those undergoing single-port laparoscopically assisted urological surgery;
- Patients classified as ASA I–III.
- Known allergies to remimazolam or remifentanil;
- History of alcohol or drug abuse, psychiatric disorders;
- Presence of acute cardiovascular diseases;
- Refractory hypertension;
- Other respiratory or neuromuscular diseases;
- Chronic pain or treatment with opioid-containing analgesics within 24 h before surgery;
- Patients who were unable to understand the PCA device or who had contraindications to self-administration of opioids.
2.3. Randomization and Procedure
2.4. Anesthesia and Perioperative Care
2.5. Mechanically Evoked Pain pPotocol
Outcome Measures
2.6. Sample Size and Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Group RHR (n = 33) | Group DHR (n = 31) | Group DLR (n = 34) | p-Value | |
---|---|---|---|---|
Age (yr) | 51.0 ± 8.5 | 49.3 ± 6.5 | 49.2 ± 7.3 | 0.524 |
Sex (F/M) | 11/22 (33.3/66.7) | 11/20 (35.5/64.5) | 14/20 (41.2/58.8) | 0.789 |
Body weight (kg) | 68.4 ± 8.4 | 69.0 ± 9.8 | 66.3± 9.6 | 0.470 |
ASA (I/II/III) | 1/14/18 (3.0/42.4/54.5) | 2/18/11 (6.5/58.1/35.5) | 0/22/12 (3.1/55.1/41.8) | 0.222 |
Type of surgery | 0.619 | |||
Nephrectomy | 11 (33.3) | 8 (25.8) | 10 (29.4) | |
Nephroureterectomy | 7 (21.2) | 12 (38.7) | 12 (35.3) | |
Prostatectomy | 15 (45.5) | 11 (35.5) | 12 (35.3) | |
Duration of operation (min) | 182.7 ± 12.3 | 186.1 ± 10.2 | 188.2 ± 11.7 | 0.146 |
Duration of anesthesia (min) | 211.8 ± 12.1 | 214.5 ± 14.3 | 219.7 ± 23.1 | 0.535 |
Total fluid administered (ml) | 1677.3 ± 120.3 | 1693.5 ± 122.3 | 1685.3± 130.6 | 0.873 |
Desflurane (vol%) | 0 | 4.5 ± 0.6 * | 6.0 ± 0.8 | <0.01 |
Total dose of remifentanil administered (mg) | 3.2 ± 0.6 * | 3.4 ± 0.7 * | 1.1 ± 0.2 | <0.01 |
Hypotension | 4 (12.1) * | 5 (16.1) * | 13 (38.2) | vs. Group RHR 0.014 vs. Group DHR 0.047 |
Bradycardia | 9 (27.3) * | 14 (45.2) * | 3 (8.8) | vs. Group RHR 0.049 vs. Group DHR <0.01 |
Ephedrine | 2 (6.1) * | 4 (12.9) | 8 (23.5) | 0.045 |
Atropine | 3 (9.1) | 2 (6.5) | 1 (2.9) | 0.574 |
Intraoperative hypothermia | 8 (24.2) *† | 16 (51.6) | 25 (73.5) | <0.01 * 0.024 † |
Hypothermia in PACU | 6 (18.2) *† | 13 (41.9) | 20 (58.8) | <0.01 * 0.024 † |
Incidence of PAS | 10 (30.3) † | 17 (54.8) * | 9 (26.5) | 0.020 * 0.047 † |
Severity of PAS | 0.16 | |||
Grade 0 | 23 (69.7) | 13 (41.9) | 25 (73.5) | |
Grade 1 | 3 (9.1) | 4 (12.9) | 3 (8.8) | |
Grade 2 | 6 (18.2) | 12 (38.7) | 6 (17.6) | |
Grade 3 | 1 (3.0) | 2 (6.5) | 0 (0) |
Group RHR (n = 33) | Group DHR (n = 31) | Group DLR (n = 34) | p-Value | |
---|---|---|---|---|
Time to first rescue analgesia (min) | 25.0 ± 10.5 † | 10.3 ± 7.2 * | 33.8 ± 10.2 | 0.01 * 0.04 † |
Total analgesic (ketorolac) consumption (mg) | 38.6 ± 7.5 | 39.7 ± 7.3 | 37.5 ± 7.6 | 0.51 |
Pain intensity at movement | ||||
VAS at 1 h | 53.3 ± 8.8 † | 59.7 ± 8.0 * | 50.5 ± 7.3 | <0.01 * <0.01 † |
VAS at 6 h | 49.8 ± 7.1 † | 55.0 ± 7.0 * | 47.9 ± 6.3 | <0.01 * <0.01 † |
VAS at 12 h | 44.3 ± 8.8 † | 51.7 ± 8.4 * | 41.5 ± 6.9 | <0.01 * <0.01 † |
VAS at 24 h | 36.1 ± 7.0 | 39.7 ± 7.6 | 35.5 ± 6.9 | 0.298 |
VAS at 48 h | 27.2 ± 6.2 | 29.1 ± 7.4 | 25.6 ± 5.6 | 0.450 |
Cumulatively consumed PCA volume containing morphine for 24 h after surgery. | 79.2 ± 10.7 † | 92.9 ± 9.4 * | 70.1 ± 9.7 | <0.01 * <0.01 † |
Preoperative mechanical hyperalgesia threshold at 24 h | 188.0 ± 18.4 | 191.3 ± 19.4 | 184.9 ± 17.6 | 0.376 |
Mechanical hyperalgesia threshold at 24 h after surgery. | 109.5 ± 28.9 † | 83.9 ± 23.5 * | 115.1 ± 21.3 | <0.01 * <0.01 † |
Area of the hyperalgesia at 24 h after surgery. | 11.9 ± 3.1 † | 15.5 ± 3.4 * | 10.2 ± 1.9 | <0.01 * <0.01 † |
Mechanical Hyperalgesia Threshold at 24 h Postoperatively | Area of the Hyperalgesia at 24 h Postoperatively | PCA Volume Containing Morphine for 24 h Postoperatively | Time to First Rescue Analgesia | Total Dose of Remifentanil Administered | Intraoperative Hypothermia | Hypothermia in PACU | |
---|---|---|---|---|---|---|---|
Incidence of PAS | rpb = −0.422 | rpb = 0.454 | rpb = 0.345 | rpb = −0.395 | rpb = 0.375 | rφ = 0.258 | rφ = 0.276 |
p < 0.001 | p < 0.001 | p < 0.001 | p < 0.001 | p < 0.001 | p < 0.001 | p < 0.001 |
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Lee, C.; Lim, J.; Hong, H.; Yu, H.; Lee, H. Effect of Remimazolam on Pain Perception and Opioid-Induced Hyperalgesia in Patients Undergoing Laparoscopic Urologic Surgery—A Prospective, Randomized, Controlled Study. Medicina 2024, 60, 123. https://doi.org/10.3390/medicina60010123
Lee C, Lim J, Hong H, Yu H, Lee H. Effect of Remimazolam on Pain Perception and Opioid-Induced Hyperalgesia in Patients Undergoing Laparoscopic Urologic Surgery—A Prospective, Randomized, Controlled Study. Medicina. 2024; 60(1):123. https://doi.org/10.3390/medicina60010123
Chicago/Turabian StyleLee, Cheol, Junsung Lim, Hansol Hong, Hyungjong Yu, and Hayoung Lee. 2024. "Effect of Remimazolam on Pain Perception and Opioid-Induced Hyperalgesia in Patients Undergoing Laparoscopic Urologic Surgery—A Prospective, Randomized, Controlled Study" Medicina 60, no. 1: 123. https://doi.org/10.3390/medicina60010123