Effects of a Very Low Dose Naloxone Addition to Intraoperative Remifentanil Infusion on Postoperative Pain in Patients Undergoing Total Hip Replacement Surgery: A Randomized Clinical Trial
-
Mohsen Sabermoghaddamranjbar
,
Saeid Jamalie Bastami
,
Alireza Sharifian Attar
,
Seyed-Hossein Khademi
,
Mohammad Alipour
,
Mahdieh Samei
,
Omid Shahpari
Abstract
Purpose: To evaluate the impact of a very low dose of naloxone added to a remifentanil infusion on postoperative pain in patients undergoing hip replacement surgery in the lateral position.
Methods: This randomized clinical trial included 80 patients candidates undergoing hip replacement surgery under general anesthesia were randomly divided into two groups of 40 using block randomization: group 1 received remifentanil at a dose of 0.3 μg/kg/min, while group 2 received remifentanil at a dose of 0.3 μg/kg/min with a very low dose of naloxone administered at 0.05 μg/kg/h following injection. Postoperative pain (measured using VAS pain assessment criteria), drowsiness caused by narcotics and analgesics in recovery, and the duration of getting out of bed were all monitored and recorded in the ward.
Results: The mean time to administration of the first sedative drug was 1.30 ± 1.89 hours in the control group and 3.20 ± 2.55 hours in the intervention group. The difference between the groups in this regard was statistically significant (P <0.0001). The frequency of pain after surgery at 0, 4 and 8 hours was significantly different between the control and intervention groups (P = 0.003, P <0.0001, and P=0.021, respectively).
Conclusions: Based on the results, we recommend using a very low dose of naloxone along with remifentanil infusion in patients undergoing complete hip replacement surgery to reduce their pain and the need for painkillers.
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10.1124/jpet.300.2.588. [PubMed: 11805221].
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intrathecal morphine on postoperative pain and morphine
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randomized, clinical trial. Open Access Maced J Med Sci.
2019;7(23):3979-83. doi: 10.3889/oamjms.2019.852. [PubMed:
32165939]. [PubMed Central: PMC7061398].
17. Makarem J, Majedi H, Bahmaee F, Mireskandari SM, Amraei F,
Yousefshahi F, et al. Evaluation of the efficacy of low-dose
naloxone for the prevention of acute remifentanil-induced
hyperalgesia in patients undergoing general anesthesia for
laparotomy. Arch Neurosci. 2020;7(4):e108836. doi:
10.5812/ans.108836.
18. Movafegh A, Nouralishahi B, Sadeghi M, Nabavian O. An ultra-
low dose of naloxone added to lidocaine or lidocaine-fentanyl
mixture prolongs axillary brachial plexus blockade. Anesth
Analg . 2009;109(5):1679-83. doi: 10.1213/ANE.0b013e3181b9e904.
[PubMed: 19843808].
19. Koo CH, Yoon S, Kim BR, Cho YJ, Kim TK, Jeon Y, et al.
Intraoperative naloxone reduces remifentanil-induced
postoperative hyperalgesia but not pain: A randomized
controlled trial. Br J Anaesth. 2017;119(6):1161-8. doi:
10.1093/bja/aex253. [PubMed: 29029049].
2003;16(4):367-72. doi: 10.1097/01.aco.0000084479.59960.3f.
[PubMed: 17021484].
2. Taylor R, Pergolizzi JV, Porreca F, Raffa RB. Opioid antagonists
for pain. Expert Opin Investig Drugs. 2013;22(4):517-25. doi:
10.1517/13543784.2013.778973. [PubMed: 23484859].
3. Heidari B, Salimi R, Saremi H, Arab GM. Assessment of
magnesium sulfate infusion in combination with ketorolac
for the pain management in intertrochanteric fractures; a
randomized clinical trial. Arch Bone Jt Surg. 2023;11(6):414-20.
doi: 10.22038/ABJS.2023.64778.3109. [PubMed: 37404294].
[PubMed Central: PMC10314985].
4. Saliminia A, Atef Yekta R, Azimaraghi O, Shamabadi A, Naderi
S, Movafegh A. Evaluation of the effect of Transversus
Abdominis Plane (TAP) block on post-laparoscopic
cholecystectomy stress responses: A randomized controlled
trial. Arch Anesth & Crit Care. 2022;8(Supp 1):399-406.
5. Gan TJ, Ginsberg B, Glass PS, Fortney J, Jhaveri R, Perno R.
Opioid-sparing effects of a low-dose infusion of naloxone in
patient-administered morphine sulfate. Anesthesiology.
1997;87(5):1075-81. doi: 10.1097/00000542-199711000-00011.
[PubMed: 9366459].
6. Crawford MW, Hickey C, Zaarour C, Howard A, Naser B.
Development of acute opioid tolerance during infusion of
remifentanil for pediatric scoliosis surgery. Anesth Analg.
2006;102(6):1662-7. doi: 10.1213/01.ane.0000216036.95705.c2.
[PubMed: 16717305].
7. Imasogie NN, Singh S, Watson JT, Hurley D, Morley-Forster P.
Ultra low-dose naloxone and tramadol/acetaminophen in
elderly patients undergoing joint replacement surgery: A pilot
study. Pain Res Manag. 2009;14(2):103-8. doi:
10.1155/2009/497217. [PubMed: 19532850]. [PubMed Central:
PMC2706645].
8. Maxwell LG, Kaufmann SC, Bitzer S, Jackson EV Jr, McGready J,
Kost-Byerly S, et al. The effects of a small-dose naloxone
infusion on opioid-induced side effects and analgesia in
children and adolescents treated with intravenous patient-
controlled analgesia: A double-blind, prospective,
randomized, controlled study. Anesth Analg. 2005;100(4):953-8.
doi: 10.1213/01.ANE.0000148618.17736.3C. [PubMed: 15781505].
9. Wang HY, Friedman E, Olmstead MC, Burns LH. Ultra-low-dose
naloxone suppresses opioid tolerance, dependence and
associated changes in mu opioid receptor-G protein coupling
and Gbetagamma signaling. Neuroscience. 2005;135(1):247-61.
doi: 10.1016/j.neuroscience.2005.06.003. [PubMed: 16084657].
10. Xiao Y, Wu L, Zhou Q, Xiong W, Duan X, Huang X. A
randomized clinical trial of the effects of ultra-low-dose
naloxone infusion on postoperative opioid requirements and
recovery. Acta Anaesthesiol Scand. 2015;59(9):1194-203. doi:
10.1111/aas.12560. [PubMed: 26041316].
11. Kim SH, Lee MH, Seo H, Lee IG, Hong JY, Hwang JH.
Intraoperative infusion of 0.6-0.9 microg.kg(-1).min(-1)
remifentanil induces acute tolerance in young children after
laparoscopic ureteroneocystostomy. Anesthesiology.
2013;118(2):337-43. doi: 10.1097/ALN.0b013e31827bd108. [PubMed:
23241726].
12. Zheng J, Han W, Han XD, Ma XY, Zhang P. Effect of naloxone on
intravenous fentanyl patient-controlled analgesia after
laparoscopic cholecystectomy. Medicine (Baltimore).
2016;95(48):e5074. doi: 10.1097/MD.0000000000005074.
[PubMed: 27902584]. [PubMed Central: PMC5134765].
13. Hu S, Sheng WS, Lokensgard JR, Peterson PK. Morphine induces
apoptosis of human microglia and neurons. Neuropharmacology.
2002;42(6):829-36. doi: 10.1016/s0028-3908(02)00030-8.
[PubMed: 12015209].
14. Li Q. Antagonists of toll like receptor 4 maybe a new strategy
to counteract opioid-induced hyperalgesia and opioid
tolerance. Med Hypotheses. 2012;79(6):754-6. doi:
10.1016/j.mehy.2012.08.021. [PubMed: 23062774].
15. Powell KJ, Abul-Husn NS, Jhamandas A, Olmstead MC, Beninger
RJ, Jhamandas K. Paradoxical effects of the opioid antagonist
naltrexone on morphine analgesia, tolerance, and reward in
rats. J Pharmacol Exp Ther. 2002;300(2):588-96. doi:
10.1124/jpet.300.2.588. [PubMed: 11805221].
16. Peivandi S, Habibi MR, Baradari AG, Gholinataj A, Habibi A,
Khademloo M, et al. The effect of adding low-dose naloxone to
intrathecal morphine on postoperative pain and morphine
related side effects after cesarean section: a double-blind,
randomized, clinical trial. Open Access Maced J Med Sci.
2019;7(23):3979-83. doi: 10.3889/oamjms.2019.852. [PubMed:
32165939]. [PubMed Central: PMC7061398].
17. Makarem J, Majedi H, Bahmaee F, Mireskandari SM, Amraei F,
Yousefshahi F, et al. Evaluation of the efficacy of low-dose
naloxone for the prevention of acute remifentanil-induced
hyperalgesia in patients undergoing general anesthesia for
laparotomy. Arch Neurosci. 2020;7(4):e108836. doi:
10.5812/ans.108836.
18. Movafegh A, Nouralishahi B, Sadeghi M, Nabavian O. An ultra-
low dose of naloxone added to lidocaine or lidocaine-fentanyl
mixture prolongs axillary brachial plexus blockade. Anesth
Analg . 2009;109(5):1679-83. doi: 10.1213/ANE.0b013e3181b9e904.
[PubMed: 19843808].
19. Koo CH, Yoon S, Kim BR, Cho YJ, Kim TK, Jeon Y, et al.
Intraoperative naloxone reduces remifentanil-induced
postoperative hyperalgesia but not pain: A randomized
controlled trial. Br J Anaesth. 2017;119(6):1161-8. doi:
10.1093/bja/aex253. [PubMed: 29029049].
| Files | ||
| Issue | Vol 10 No 4 (2024) | |
| Section | Research Articles | |
| DOI | https://doi.org/10.18502/jost.v10i4.17358 | |
| Keywords | ||
| Naloxone Remifentanil Pain Surgery Hip | ||
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How to Cite
1.
Sabermoghaddamranjbar M, Jamalie Bastami S, Sharifian Attar A, Khademi S-H, Alipour M, Samei M, Shahpari O. Effects of a Very Low Dose Naloxone Addition to Intraoperative Remifentanil Infusion on Postoperative Pain in Patients Undergoing Total Hip Replacement Surgery: A Randomized Clinical Trial. J Orthop Spine Trauma. 2024;10(4):160-5.
