Effects of low-dose remifentanil infusion on analgesic or antiemetic requirement during brain function mapping: A retrospective cohort study.

Abstract

BACKGROUND:

Pain and discomfort during the awake phase in awake craniotomy should be relieved to facilitate brain mapping. Although some anaesthesiologists use low-dose (0.01-0.05 µg/kg/min) remifentanil infusion to provide analgesia during this phase, its efficacy and side effects have never been evaluated. Therefore, this study primarily aimed to investigate the effects of low-dose remifentanil infusion on the need for antiemetic treatment during brain mapping and secondarily aimed to determine its effects on the need for additional analgesic treatment.

METHODS:

This retrospective study included 218 patients who underwent awake craniotomy at our centre from 2008 to 2018. The relationship between low-dose remifentanil infusion during the awake phase and the requirement for analgesic or antiemetic treatment was examined. A multivariable competing risk regression analysis was performed to adjust for patient and operative variables.

RESULTS:

Sixty-six patients (30.3%) received low-dose (median rate: 0.01 µg/kg/min) remifentanil infusion during the awake phase. Forty-nine patients (22.5%) received an antiemetic and 99 (45.4%) received additional analgesic treatment. The difference in additional analgesic treatment was not significant between patients who received low-dose remifentanil infusion and those who did not (adjusted hazard ratio: 1.13; 95% confidence interval: 0.75-1.70; P = .570); however, the use of antiemetics significantly increased in patients who received remifentanil (adjusted hazard ratio: 1.78; 95% confidence interval: 1.01-3.15; P = .047).

CONCLUSION:

Low-dose remifentanil infusion during the awake phase in awake craniotomy significantly increased the need for antiemetics but did not decrease the need for additional analgesic treatment.

• Authors: Atsuko Shiraki, Wataru Goto, Hiroshi Fukagawa, Yoshiki Arakawa, Takayuki Kikuchi, Yohei Mineharu, Yukihiro Yamao, Takayuki Yasuda, Etsuko Hattori, Ayaka Fukui, Yoshihiro Matsui, Atsushi Yonezawa, Keiko Furukawa, Toshiyuki Mizota
• Journal: Acta anaesthesiologica Scandinavica (Acta Anaesthesiol Scand) Vol. 64 Issue 6 Pg. 735-741 (07 2020) ISSN: 1399-6576 [Electronic] England
• PMID: 31997302 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2020 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Chemical References

• Analgesics
• Analgesics, Opioid
• Antiemetics
• Remifentanil

Topics

• Adult
• Analgesics (administration & dosage)
• Analgesics, Opioid (administration & dosage, pharmacology)
• Antiemetics (administration & dosage)
• Brain (surgery)
• Brain Mapping (methods)
• Cohort Studies
• Craniotomy
• Female
• Humans
• Infusions, Intravenous
• Male
• Middle Aged
• Pain (drug therapy)
• Remifentanil (administration & dosage, pharmacology)
• Retrospective Studies
• Treatment Outcome
• Wakefulness