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
Background: The objective of this study was to assess the effect of adding a very low dose of naloxone to a remifentanil infusion on postoperative pain in patients undergoing hip replacement surgery in the lateral position.
Methods: This randomized clinical trial involved 80 patients who underwent hip replacement surgery under general anesthesia and were randomly assigned into two groups through block randomization: group 1 received remifentanil at a dose of 0.3 μg/kg/minute, while group 2 received remifentanil at a dose of 0.3 μg/kg/minute with a very low dose of naloxone administered at 0.05 μg/kg/hour following injection. Postoperative pain [measured using the visual analog scale (VAS)], 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 median [interquartile range (IQR)] of time to administration of the first sedative drug was 0 (0, 4) hours in the control group and 4 (0, 4) hours in the intervention group. The difference between the groups 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).
Conclusion: 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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remifentanil induces acute tolerance in young children after laparoscopic ureteroneocystostomy. Anesthesiology.
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[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].
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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].
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].
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| Issue | Vol 10 No 4 (2024) | |
| Section | Research Articles | |
| DOI | https://doi.org/10.18502/jost.v10i4.17358 | |
| Keywords | ||
| Naloxone Remifentanil Pain Hip Randomized Controlled Trial | ||
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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.
