Abstract Rationale In thoracic anesthesia, the intraoperative opioid regimen plays a critical role in modulating postoperative pain and recovery. While remifentanil allows precise titration and rapid offset, it has been associated with opioid-induced hyperalgesia (OIH) in surgical patients (1). Conversely, fentanyl provides longer-lasting analgesia but carries a higher risk of accumulation and delayed emergence. Despite extensive use of both opioids, evidence directly comparing their influence on early postoperative pain in thoracic procedures remains limited. This study aimed to compare early postoperative pain intensity between patients receiving remifentanil and fentanyl during video-assisted thoracoscopic surgery (VATS). Methods We conducted a retrospective cohort study including 230 adult patients who underwent VATS between 2022 and 2024 at a tertiary care hospital. Patients were categorized according to intraoperative opioid use: fentanyl (0) or remifentanil (1). Postoperative pain at 12 hours was assessed using the Visual Analog Scale (VAS 0-10) and categorized as absent (VAS = 0), mild (VAS 1-3), or moderate-severe (VAS 4). Both groups received transitional analgesia with opioids equivalent to morphine, administered under the institutional postoperative pain protocol. This standardized approach ensured comparable exposure to systemic opioids during the transition phase. Comparative analyses between groups were performed using chi-square or Fisher’s exact test, with statistical significance set at p 0.05. Results Among the 230 patients, 10 (4.3%) received fentanyl and 220 (95.7%) received remifentanil. Pain intensity at 12 hours was generally low in both groups. Patients receiving remifentanil showed a higher proportion of mild and moderate-severe pain, consistent with previously described OIH patterns (1).Although the differences were not statistically significant, a numerical trend toward greater pain intensity was observed in the remifentanil group, aligning with prior evidence of opioid-induced hyperalgesia in thoracic anesthesia (1,2). Conclusions In this cohort of thoracoscopic surgery patients, remifentanil-based anesthesia was associated with a higher proportion of mild and moderate-severe pain at 12 hours compared with fentanyl-based anesthesia, though differences did not reach statistical significance. These findings are consistent with prior reports of remifentanil-related postoperative hyperalgesia and support the need for further prospective studies assessing cumulative opioid dose, adjunct analgesic strategies, and multimodal approaches to optimize postoperative recovery. References: 1. Fletcher D, Martinez V. Opioid-induced hyperalgesia in patients after surgery: a systematic review. Br J Anaesth.2014;112(6):991-1004. 2. Song J, Shim JK, Yoo YC, et al. Postoperative pain and recovery profiles after remifentanil- versus fentanyl-based anesthesia for thoracic surgery. J Thorac Cardiovasc Surg. 2015;149(3):894-900. This abstract is funded by: none
Montoya et al. (2026) studied this question.