The concept of Enhanced Recovery After Surgery(ERAS) has been prevalent in recent years. In the ERAS guideline, short-acting anesthetics, instead of long-acting opioid anesthetics, were recommended during surgery to decrease post-operative complication and length of hospital stay. Propofol-remifentanil based total intravenous anesthesia (TIVA) can provide quicker emergence and decreased post-operative nausea and vomiting. However, the prescription of opioid (especially remifentanil) may induce opioid-induced hyperalgesia (OIH) and increase the requirement of analgesics. Previous studies provided some strategies to prevent OIH. The purpose of this study is to investigate the effect of adding remifentanil(1 mcg/kg) after emergence and endotracheal extubation in breast cancer females receiving breast surgery under propofol-remifentanil based TIVA for the prevention of OIH.
1. After obtaining informed consent, patients will be randomized into two groups. 2. All patients receive remifentanil-propofol based TIVA and Bispectral index (BIS) monitor during breast surgery. In the end of surgery, intravenous NSAID(keto) 30mg and local anestehsia (Marcaine) infiltration around the surgical wound will be prescribed to reduce post-operative pain. 3. group R(intervention): remifentanil 1mcg/kg diluted with 0.9% saline to 50ml and drip for 30 minutes after emergence and extubation of endotracheal tube 4. group N(no intervention): 0.9% saline 50ml drip for 30 minutes after emergence and extubation of endotracheal tube 5. In post-anesthesia room: record the numerical rating scale (NRS); requirement of additional analgesics (rescue medication), blood pressure, heart rate, pulse oximeter, degree of nausea, vomiting 6. In ward: record the numerical rating scale (NRS) and total analgesics consumption
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
DOUBLE
Enrollment
100
remifentanil 1mcg/kg added in 0.9% saline and diluted to 50ml
Tri-Service General Hospital
Taipei, Taiwan
RECRUITINGNumerical Rating Score (NRS) for pain score in post-anesthesia room (PAR)
1.The pain after breast surgery is moderate and suppose to be reduced after combined prescription of NSAID and local analgesics. Post-operative pain is supposed to be related with hyperalgesia. 2.Record the degree of post-operative pain by Numerical Rating Scale (Numerical Rating Scale)(0-10; 0= no pain; 10=pain as bad as can be)
Time frame: 0 minutes
Numerical Rating Score (NRS) for pain score in post-anesthesia room (PAR)
1.The pain after breast surgery is moderate and suppose to be reduced after combined prescription of NSAID and local analgesics. Post-operative pain is supposed to be related with hyperalgesia. 2.Record the degree of post-operative pain by Numerical Rating Scale (Numerical Rating Scale)(0-10; 0= no pain; 10=pain as bad as can be)
Time frame: 30 minutes
The amount analgesic requirement in post-anesthesia room (PAR)
1.The pain after breast surgery is moderate and suppose to be reduced after combined prescription of NSAID and local analgesics during surgery. Post-operative pain is supposed to be related with hyperalgesia. 2.Record the degree of post-operative pain by record additional analgesics amount (rescue medication, mg) in PAR
Time frame: 30 minutes
degree of post-operative nausea in post-anesthesia room (PAR)
Record the degree of nausea in PAR: mild, moderate, severe
Time frame: 30 minutes
degree of post-operative vomiting in post-anesthesia room (PAR)
Record the degree of vomiting in PAR: mild, moderate, severe
Time frame: 30 minutes
post-operative blood pressure in post-anesthesia room (PAR)
Record the blood pressure(mmHg) in PAR
Time frame: 0 minutes
post-operative systolic blood pressure in post-anesthesia room (PAR)
Record the systolic blood pressure(mmHg) in PAR
Time frame: 0 minutes
post-operative systolic blood pressure in post-anesthesia room (PAR)
Record the systolic blood pressure(mmHg) in PAR
Time frame: 30 minutes
post-operative diastolic blood pressure in post-anesthesia room (PAR)
Record the diastolic blood pressure(mmHg) in PAR
Time frame: 30 minutes
post-operative heart rate in post-anesthesia room (PAR)
Record the heart rate (beat/min) in PAR
Time frame: 0 minutes
post-operative heart rate in post-anesthesia room (PAR)
Record the heart rate (beat/min) in PAR
Time frame: 30 minutes
post-operative pulse oximeter in post-anesthesia room (PAR)
Record the pulse oximeter(SpO2; %) in PAR
Time frame: 0 minutes
postoperative pulse oximeter in post-anesthesia room (PAR)
Record the pulse oximeter(SpO2; %) in PAR
Time frame: 30 minutes
Numerical Rating Score (NRS) for pain score in ward
Record the degree of post-operative pain by Numerical Rating Scale (NRS)(0-10; 0= no pain; 10=pain as bad as can be)
Time frame: 1 hour after transferring to ward
Numerical Rating Score (NRS) for pain score in ward
Record the degree of post-operative pain by Numerical Rating Scale (NRS)(0-10; 0= no pain; 10=pain as bad as can be)
Time frame: 2 hours after transferring to ward
Numerical Rating Score (NRS) for pain score in ward
Record the degree of post-operative pain by Numerical Rating Scale (NRS)(0-10; 0= no pain; 10=pain as bad as can be)
Time frame: 4 hours after transferring to ward
Numerical Rating Score (NRS) for pain score in ward
Record the degree of post-operative pain by Numerical Rating Scale (NRS)(0-10; 0= no pain; 10=pain as bad as can be)
Time frame: 8 hours after transferring to ward
Numerical Rating Score (NRS) for pain score in ward
Record the degree of post-operative pain by Numerical Rating Scale (NRS)(0-10; 0= no pain; 10=pain as bad as can be)
Time frame: 24 hours after transferring to ward
total analgesics requirement in ward
Record total analgesic requirement (mg) in ward
Time frame: 24hr after transferring to ward
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