Reducing Opioid Induced Hyperalgesia After Scoliosis Repair: Fentanyl vs Remifentanil
Adolescent idiopathic scoliosis (AIS) is an abnormal deviation of the spinal axis that has no underlying cause and affects children from ages 10-18 years old.
Remifentanil and fentanyl have been associated with development of opioid induced hyperalgesia (OIH). There has been minimal work on the association, between intraoperative fentanyl and OIH.
This study aims to approach the problem of remifentanil induced hyperalgesia by examining the possible impact that switching to intraoperative fentanyl may have on reducing OIH.
We hypothesized that patients undergoing operative management of AIS would have decreased opioid consumption and pain scores. when an intraoperative fentanyl infusion was used as the primary narcotic as opposed to a remifentanil infusion
A retrospective chart review of 62 patients from 2012 to 2015 who were diagnosed with AIS and received surgical fixation (all-pedicle screw instrumentation).
Exclusion criteria: chronic disease associated with scoliosis, cognitive impairment, non-English speaking patients, preoperative pain, previous spinal fusion, or history of pain syndrome. Eight patients were excluded from the study.
Primary outcomes: total narcotic use (morphine equivalents) in the first 24 hours post-surgery. Secondary outcomes: mean post-operative pain score in the first 24 hours post-surgery, time to extubation, length of stay, and incidence of post-operative nausea and vomiting.
Univariate analysis: Mann-Whitney rank sum or two-sample t test for means, Fischer exact test for categorical
Multivariate analysis: Multiple Linear Regression adjusting for age, sex, number of osteotomies
Research into the therapeutic attenuation of remifentanil generated OIH in postoperative scoliosis patients has yet to yield significant results
This study assessed the use of fentanyl as an opioid-sparing alternative (to remifentanil) for intraoperative infusion.
In patients with AIS undergoing surgical management, intraoperative fentanyl:
Significantly increased opioid use and pain scores in the first 24 hours post-surgery in comparison to remifentanil, notably in the older patients.
This pattern suggests that patients experience increased hyperalgesia or acute tolerance when given fentanyl rather than remifentanil intraoperatively.
Limitations: retrospective chart review, patient population skewed