Remifentanil, sufentanil may be linked with poor pain outcomes after elective surgery
Key takeaways:
- Intraoperative use of remifentanil and sufentanil was associated with poor pain scores after elective surgery.
- Patients who underwent orthopedic surgery were less likely to have poor pain outcomes.
Published results showed intraoperative use of remifentanil and sufentanil was independently associated with poor postoperative pain outcomes for patients undergoing elective surgery with general anesthesia.
Multivariate analysis revealed patient age, absence of premedication and orthopedic surgery were associated with lower likelihoods of poor postoperative pain outcomes.
“Orthopedic surgery involves procedures with high pain burdens, making effective postoperative analgesia essential,” Axel Maurice-Szamburski, MD, PhD, from the department of anesthesiology and intensive care medicine at CHU Pasteur Nice University Hospital in France, told Healio. “Reducing intraoperative opioid use by prioritizing regional anesthesia can enhance patient comfort, accelerate rehabilitation and improve overall satisfaction.”
Maurice-Szamburski and colleagues analyzed data from 971 patients (median age, 49.6 years) who underwent elective surgery with general anesthesia at five teaching hospitals in France.
Primary outcome measure was patients’ pain experience on postoperative day 1, which was measured with the Evaluation du Vécu de l’Anesthésie Generale (EVAN-G) questionnaire. According to the study, a poor pain experience was defined as an EVAN-G score for the pain dimension below the 25th percentile.
Overall, 271 patients (27.9%) had a poor pain experience on postoperative day 1.
After multivariate analysis, Maurice-Szamburski and colleagues found intraoperative use of remifentanil and sufentanil (OR = 26.96; 95% CI, 2.17-334.23), administration of anxiolytics (OR = 8.2; 95% CI, 2.67-25.2) and perioperative amnesia (OR = 1.58; 95% CI, 1.22-2.06) were independent predictors of a poor postoperative pain experience on postoperative day 1.
Age (OR = 0.97; 95% CI, 0.95-0.99), absence of premedication (OR = 0.49; 95% CI, 0.25-0.95) and orthopedic surgery (OR = 0.29; 95% CI, 0.12-0.69) were associated with lower likelihoods of a poor postoperative pain experience.
“Reevaluating perioperative pain management strategies to minimize opioid exposure while expanding regional anesthesia use may lead to better pain control, lower postoperative opioid requirements and, potentially, a reduced risk of chronic pain development,” Maurice-Szamburski said.
“Future research should focus on randomized trials comparing opioid-free or opioid-sparing anesthesia protocols in orthopedic surgery. Studies should assess the impact of various regional techniques on short- and long-term pain outcomes and patient-reported experience,” he concluded.
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