[Effects of remifentanil gradual withdrawal on remifentanil induced postoperative hyperalgesia].

Objective: To explore the effects of remifentanil gradual withdrawal on remifentanil induced postoperative hyperalgesia. Methods: Ninety patients from January to June 2018 undergoing elective laparoscopic hysterectomy under general anaesthesia at Ningbo NO.2 hospital, ASA Ⅰ or Ⅱ grade, aged 20-60, were enrolled in this study and randomly assigned to 3 groups (n=30): Group L (low dose remifentanil), Group H (high dose remifentanil) and Group G (high dose remifentanil with gradual withdrawal). Mechanical pain thresholds (MPT), visual analogue scale (VAS) and additional analgesics were recorded at 6 and 24 hours after the operation. Results: There was no significant difference among the VAS and additional analgesics in three groups at 6 and 24 hours after operation (P>0.05). There was no significant difference among the MPT in three groups before operation (P>0.05). The MPT of group L, group H and group G were (49.8±12.2), (35.5±13.0) and (48.6±11.4) g at 6 hours after surgery, and (51.4±14.3), (36.9±11.1) and (48.8±11.5) g at 24 hours after surgery, respectively, with statistically significant differences (F=12.6, 11.668, both P<0.01). The MPT of group H at 6 h and 24 h after surgery was lower than that of group L (all P<0.01), while the MPT of group G at 6 h and 24 h after surgery was significantly higher than that of group H (all P<0.01). No correlation was observed between MPT and VAS scores or additional analgesics at 6 and 24 hours postoperatively (P>0.05). Conclusion: Remifentanil gradual withdrawal significantly alleviated intraoperative administration of remifentanil induced postoperative hyperalgesia in laparoscopic hysterectomy patients.目的： 观察逐渐停药对瑞芬太尼持续输注所致痛觉过敏和术后疼痛的影响。 方法： 2018年1至6月于宁波市第二医院行择期腹腔镜子宫切除术患者90例。美国麻醉医师协会（ASA）分级Ⅰ或Ⅱ级，年龄20~60岁。EXCEL软件随机分为3组（n=30）：L组（小剂量瑞芬太尼组）、H组（大剂量瑞芬太尼组）和G组（大剂量瑞芬太尼逐渐停药组）。记录术后6、24 h时的机械痛阈值、疼痛视觉模拟评分（VAS）和镇痛药物消耗量。 结果： 3组患者术后6、24 h时的VAS评分和吗啡累积消耗量差异均无统计学意义（均P>0.05）；3组患者术前的机械痛阈值差异无统计学意义（P>0.05）。L组、H组、G组术后6 h的机械痛阈值分别为（49.8±12.2）、（35.5±13.0）和（48.6±11.4）g，术后24 h分别为（51.4±14.3）、（36.9±11.1）和（48.8±11.5）g，差异均有统计学意义（F=12.600、11.668，均P<0.01）。H组患者术后6、24 h的机械痛阈值低于L组（均P<0.01），而G组患者术后6 h和24 h的机械痛阈值显著高于H组（均P<0.01）。术后6 h和24 h，机械痛阈值与VAS评分、吗啡累积消耗量之间无显著相关性（均P>0.05）。 结论： 逐渐停药能够减轻腹腔镜子宫切除术患者大剂量瑞芬太尼持续输注所致的术后痛觉过敏。.