갑상선 절제술을 받는 환자들에서 remifentanil 지속주입이 수술 직후 통증에 미치는 영향 : Effect of intraoperative remifentanil infusion on immediate postoperative pain in patients underwent thyroidectomy

다국어 초록 (Multilingual Abstract)

Remifentanil is a potent ultra-short acting synthetic opioid and a direct μ-opioid receptor agonist, which can be applied to various groups of patients regardless of hepatic and renal condition. Opioid-induced hyperalgesia is regarded as a problem of intraoperative remifentanil infusion since several years ago, but there are still discrepancies in the results of clinical human studies. This retrospective study aimed to clarify whether the remifentanil infusion causes severe pain at immediate postoperative period in patients underwent thyroidectomy.
We retrospectively assessed 2,021 patients aged 20 years or over who underwent thyroidectomy for 1 year between January 1, 2013 and December 31, 2013 at Asan Medical Center. Every enrolled patient was divided into two groups; without intraoperative remifentanil (Group N), or with intraoperative remifentanil infusion (Group R). The propensity score matching was done and 343 patients were included in each group finally. The pain scores based on Numeric Rating Scales (NRS) for pain at postoperative anesthetic care unit and at ward until postoperative 2 days were compared between two groups. Moreover, incidence of postoperative complications, such as nausea and shivering were compared.
NRS of pain at post-anesthetic care unit was 4.4 ± 2.1 in group N and 6.4 ± 2.2 in group R (P < 0.001) and there was no statistically significant difference of NRS at ward between two groups. Also, compared to Group N (73.6%), postoperative nausea was more frequent in group R (87.6%) despite of anti-emetics (P = 0.001).
In conclusion, remifentanil-based anesthesia can cause opioid-induced hyperalgesia, at least, during immediate postoperative period in patients underwent thyroidectomy. Also, intraoperative remifentanil infusion is related with more incidence of postoperative nausea and vomiting.

목차 (Table of Contents)

• Abstract------------------------------------------i
• Lists of Tables and Figures ---------------------iii
• Introduction--------------------------------------1
• Methods-------------------------------------------2
• Study population--------------------------------2
• Anesthetic management and design----------------2
• Statistical analysis----------------------------3
• Results-------------------------------------------4
• Discussion---------------------------------------13
• Conclusion---------------------------------------15
• References---------------------------------------16
• Korean Abstract----------------------------------19