Key result
Remifentanil >0.2 μg/kg/min linked to ~52% higher risk of chronic postsurgical pain at 1 year.
Why the study?
Remifentanil infusion doses >0.2 μg/kg/min are linked to hyperalgesia and acute postsurgical pain, but their contribution to chronic postsurgical pain after video-assisted thoracic surgery remains unclear.
Does a remifentanil infusion dose >0.2 μg/kg/min increase chronic postsurgical pain in older adults undergoing video-assisted thoracic surgery?
Cohort (n=258)
Does a remifentanil infusion dose >0.2 μg/kg/min increase chronic postsurgical pain in older adults undergoing video-assisted thoracic surgery?
Odds Ratio: 1.52 (95% CI 1.03–2.27)
High-dose remifentanil infusion (>0.2 μg/kg/min) during video-assisted thoracic surgery is associated with an increased risk of chronic postsurgical pain at 1 year.
May warrant limiting remifentanil to ≤0.2 μg/kg/min during video-assisted thoracic surgery; leaves open causal confirmation in randomized trials.
A remifentanil infusion dose of >0.2 μg/kg/min is associated with hyperalgesia, leading to acute postsurgical pain; however, its contribution to the development of chronic postsurgical pain after video-assisted thoracic surgery remains unclear. This study aimed to evaluate the impact of different remifentanil doses on chronic postsurgical pain after video-assisted thoracic surgery. This study included inpatients aged ≥ 55 years who underwent video-assisted thoracic surgery under general anesthesia between April 2016 and December 2018. An inverse probability of treatment weighted using stabilized inverse propensity scores was adopted to minimize bias. After adjustments based on patient data, the outcomes of interest were compared with intraoperative covariates using a generalized estimating equation. The primary study outcome was chronic postsurgical pain 1 year after surgery, defined as a pain score ≥1 on a numerical rating scale. Of the 262 eligible patients, 258 with a mean age of 71.2 years were included in this analysis. Chronic postsurgical pain occurred in 23.6% of patients. The generalized estimating equation revealed that a remifentanil infusion dose >0.2 μg/kg/min was associated with chronic postsurgical pain at 1 year after surgery (odds ratio [OR] 1.52; 95% confidence interval [CI] 1.03-2.27), while remifentanil infusion doses >0.15 μg/kg/min (OR 1.12; 95% CI 0.79-1.59) and >0.175 μg/kg/min (OR 1.17; 95% CI 0.83-1.64) were not associated with our primary outcome. Remifentanil infusions >0.2 μg/kg/min were associated with chronic postsurgical pain 1 year after video-assisted thoracic surgery.
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Wang et al. (2023) conducted a cohort in Chronic postsurgical pain after video-assisted thoracic surgery (n=258). Remifentanil infusion dose >0.2 μg/kg/min vs. Lower remifentanil infusion doses was evaluated on Chronic postsurgical pain 1 year after surgery, defined as a pain score ≥1 on a numerical rating scale (OR 1.52, 95% CI 1.03-2.27). A remifentanil infusion dose >0.2 μg/kg/min during video-assisted thoracic surgery was associated with chronic postsurgical pain at 1 year (OR 1.52; 95% CI 1.03-2.27).
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