Drip-infusion of Remifentanil for RIH


The development of remifentanil-induced hyperalgesia (RIH) is an unpleasant experience for surgical patients. An alternative management, gradual withdrawal of remifentanil was effective in prevention of RIH. The investigators designed a simple modality to assess if under withdrawal of remifentanil and further drip-infusion of remifentanil immediately after extubation affected postoperative pain score, the requirement of rescue analgesics, and adverse effects.

Full Title of Study: “Postoperative Drip-infusion of Remifentanil for Preventing Remifentanil-induced Hyperalgesia- a Retrospective Observative Study”

Study Type

  • Study Type: Observational
  • Study Design
    • Time Perspective: Retrospective
  • Study Primary Completion Date: January 31, 2019

Detailed Description

In clinical practice, the gradual withdrawal of remifentanil during surgery is unsatisfied. Thus, the investigators conducted a simple modality in a single center retrospective cohort study to assess how under baseline gradual withdrawal of remifentanil and further drip infusion of remifentanil immediately after extubation affected postoperative pain score and use of analgesics.


  • Drug: remifentanil
    • postoperative drip-infusion of remifentanil

Arms, Groups and Cohorts

  • gradual withdrawal following by drip-infusion of remifentanil
    • In the end of the surgery, gradual withdrawal of remifentanil was prescribed until the endotracheal tube was extubated. Following by drip-infusion of remifentanil for 30 minutes was administered immediately after tracheal extubation.
  • gradual withdrawal of remifentanil
    • In the end of the surgery, gradual withdrawal of remifentanil was prescribed until the endotracheal tube was extubated.

Clinical Trial Outcome Measures

Primary Measures

  • comparison of the numeric rating scale (NRS) between 2 groups
    • Time Frame: one hour
    • NRS scores is labeled from zero to ten, with zero being an example of someone with no pain and ten being the worst pain possible.
  • requirement for rescue analgesics
    • Time Frame: one hour
    • postoperative requirement for rescue analgesics

Secondary Measures

  • type of surgery
    • Time Frame: three hours
    • type of surgery in both groups
  • surgical site
    • Time Frame: three hours
    • surgical site in both groups

Participating in This Clinical Trial

Inclusion Criteria

  • American Society of Anesthesiologists (ASA) score of I-III patients receiving total intravenous anesthesia Exclusion Criteria:

  • The use of inhalation agents or propofol combined with inhalation anesthesia – Pregnancy – Previous substance abuse – Known allergies to opioids, propofol or any drugs used in the study – History of neuropsychiatric disorder – Age < 20 years or > 80 years

Gender Eligibility: All

Minimum Age: 20 Years

Maximum Age: 80 Years

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Tri-Service General Hospital
  • Provider of Information About this Clinical Study
    • Principal Investigator: Yi-hsuan Huang, Principal Investigator – Tri-Service General Hospital
  • Overall Official(s)
    • Yi-hsuan Huang, MD, Principal Investigator, Tri-Service General Hospital and National Defense Medical Center

Citations Reporting on Results

Comelon M, Raeder J, Stubhaug A, Nielsen CS, Draegni T, Lenz H. Gradual withdrawal of remifentanil infusion may prevent opioid-induced hyperalgesia. Br J Anaesth. 2016 Apr;116(4):524-30. doi: 10.1093/bja/aev547. Epub 2016 Mar 1.

Saxena S, Gonsette K, Terram W, Huybrechts I, Nahrwold DA, Cappello M, Barvais L, Engelman E. Gradual withdrawal of remifentanil delays initial post-operative analgesic demand after thyroid surgery; double-blinded, randomized controlled trial. BMC Anesthesiol. 2019 Apr 25;19(1):60. doi: 10.1186/s12871-019-0731-9.

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