Impact of different doses of remifentanil on postoperative pain and hyperalgesia: a prospective randomized controlled study and genotypic analysis

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2026-04-01 Epub Date: 2026-03-30 DOI:10.1016/j.jclinane.2026.112198

Zixuan Xu MD , Jiayi Zhang MD , Linyao Chen MD , Jianwen Ye MD , Yanan Wang MD , Lei Tan MD , Jiehao Sun MD

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引用次数: 0

Abstract

Background

Remifentanil is commonly used for perioperative analgesia, but its role in postoperative pain and hyperalgesia is still debated. This study investigated the effect of different remifentanil doses on postoperative pain and hyperalgesia and the influence of SCN9A genetic variants on these outcomes.

Methods

A total of 268 patients who underwent laparoscopic surgery were included in the study. Eligible patients were randomly assigned to one of three groups: a high dose of remifentanil (Group H), a low dose of remifentanil (Group L), or no remifentanil (Group N). Postoperative pain intensity and mechanical pain thresholds were assessed after surgery, and side effects were recorded during follow-up. The single-nucleotide polymorphisms of SCN9A, rs16851799 and rs6746030, were also analyzed.

Results

There were no differences in postoperative pain scores among the three groups with different remifentanil doses (P = 0.969). However, the mechanical pain thresholds were significantly lower in Group H compared with the other groups postoperatively (P < 0.001). The A allele of rs6746030 was associated with higher pain scores (P = 0.002) and increased postoperative analgesic requirements (P = 0.013).

Conclusions

While high doses of remifentanil significantly induced detectable hyperalgesia in a laboratory phenomenon, RIH had zero clinical impact on the patient's actual pain experience or analgesic requirements after surgery. Additionally, the exploratory findings revealed that rs6746030 in SCN9A was a genetic marker for severe postoperative pain.

查看原文本刊更多论文

不同剂量瑞芬太尼对术后疼痛和痛觉过敏的影响：一项前瞻性随机对照研究和基因型分析。

背景：瑞芬太尼常用于围手术期镇痛，但其在术后疼痛和痛觉过敏中的作用仍有争议。本研究探讨了不同剂量的瑞芬太尼对术后疼痛和痛觉过敏的影响，以及SCN9A基因变异对这些结果的影响。方法：共纳入268例腹腔镜手术患者。符合条件的患者被随机分为三组：高剂量瑞芬太尼（H组）、低剂量瑞芬太尼（L组）或不使用瑞芬太尼（N组）。术后评估疼痛强度和机械性疼痛阈值，随访时记录不良反应。分析了SCN9A基因rs16851799和rs6746030的单核苷酸多态性。结果：不同瑞芬太尼剂量组术后疼痛评分差异无统计学意义（P = 0.969）。然而，术后H组的机械痛阈值明显低于其他组(P结论：虽然高剂量瑞芬太尼在实验室现象中显著诱导可检测到的痛觉过敏，但RIH对患者术后实际疼痛体验或镇痛需求的临床影响为零。此外，探索性发现发现SCN9A中的rs6746030是术后严重疼痛的遗传标记。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.