Evaluation of antihyperalgesic and analgesic effects of 35% nitrous oxide when combined with remifentanil: A randomised phase 1 trial in volunteers.
Eur J Anaesthesiol
; 38(12): 1230-1241, 2021 12 01.
Article
em En
| MEDLINE
| ID: mdl-34735395
ABSTRACT
BACKGROUND:
Remifentanil is an effective drug in peri-operative pain therapy, but it can also induce and aggravate hyperalgesia. Supplemental administration of N2O may help to reduce remifentanil-induced hyperalgesia.OBJECTIVE:
To evaluate the effect of 35 and 50% N2O on hyperalgesia and pain after remifentanil infusion.DESIGN:
Single site, phase 1, double-blind, placebo-controlled, randomised crossover study.SETTING:
University Hospital, Germany from January 2012 to April 2012.PARTICIPANTS:
Twenty-one healthy male volunteers.INTERVENTIONS:
Transcutaneous electrical stimulation induced spontaneous acute pain and stable areas of hyperalgesia. Each volunteer underwent the following four sessions in a randomised order 50 to 50% N2-O2 and intravenous (i.v.) 0.9% saline infusion (placebo); 50 to 50% N2-O2 and i.v. remifentanil infusion at 0.1 µg kg-1 min-1 (remifentanil); 35 to 15 to 50% N2O-N2-O2 and i.v. remifentanil infusion at 0.1 µg kg-1 min-1 (tested drug) and 50 to 50% N2O-O2 and i.v. remifentanil infusion at 0.1 µg kg-1 min-1 (gas active control). Gas mixtures were inhaled for 60âmin; i.v. drugs were administered for 30 min. MAIN OUTCOMEMEASURES:
Areas of pin-prick hyperalgesia, areas of touch-evoked allodynia and pain intensity on a visual analogue scale were assessed repeatedly for 160âmin.RESULTS:
Data from 20 volunteers were analysed. There were significant treatment and treatment-by-time effects regarding areas of hyperalgesia (Pâ<â0.001). After the treatment period, the area of hyperalgesia was significantly reduced (Pâ<â0.001) in the tested drug and in the gas active control (30.6â±â9.25 and 24.4â±â7.3âcm2, respectively) compared with remifentanil (51.0â±â17.0âcm2). There was also a significant difference between the gas active control and the tested drug sessions (Pâ<â0.001). For the area of allodynia and pain rating, results were consistent with the results for hyperalgesia.CONCLUSIONS:
Administration of 35% N2O significantly reduced hyperalgesia, allodynia and pain intensity induced after remifentanil. It might therefore be suitable in peri-operative pain relief characterised by hyperalgesia and allodynia, such as postoperative pain, and may help to reduce opioid demand. TRIAL REGISTRATION EudraCT-No. 2011-000966-37.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Piperidinas
/
Óxido Nitroso
Tipo de estudo:
Clinical_trials
/
Diagnostic_studies
Limite:
Humans
/
Male
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article