Low-dose remifentanil as an adjunct analgesic is not associated with clinically important opioid-induced hyperalgesia: secondary analysis from a randomized controlled trial
Bibliographic record
Abstract
BACKGROUND: Remifentanil, as the primary opioid or in high doses, is associated with opioid-induced hyperalgesia. We assessed outcomes of pain and opioid use with low-dose remifentanil as an adjunct analgesic after same-day surgeries. METHODS: This prospective cohort study was nested within a randomized controlled trial showing no difference in achieving satisfactory analgesia in the postanesthetic care unit with morphine or hydromorphone. Primary outcomes were pain scores in the postanesthetic care unit and 24 hours after surgery between patients who received remifentanil (R group) or those who received non-remifentanil opioid regimens (C group). We also evaluated pain scores in the day surgical unit, dose of long-acting opioids, and need for non-steroidal anti-inflammatory drugs. The association of remifentanil dose with outcomes was explored using linear regression. RESULTS: Patients in both groups (R=276, C=126) had comparable baseline characteristics. There were no differences in maximum postanesthetic care unit pain scores or average pain scores 24 hours after surgery: mean difference 0.3 (95% CI -0.9 to 0.2) and 0.4 (95% CI -1.7 to 0.9), respectively. In the R group, the dose of long-acting opioids in postanesthetic care unit was higher: mean difference 0.97 mg (95% CI 0.2 to 1.7) intravenous morphine equivalents, p=0.01. Adjusted analyses indicated that higher doses of remifentanil (25 mcg increments) were associated with higher maximum pain scores in day surgical unit: 0.23 units (95% CI 0.05 to 0.41), p=0.01; higher average pain scores 24 hours after surgery: 0.25 units (95% CI 0.036 to 0.46), p=0.02; and higher long-acting opioid doses in postanesthetic care unit: 0.14 mg intravenous morphine equivalents (95% CI 0.02 to 0.25), p=0.02. CONCLUSION: Opioid-induced hyperalgesia and increased opioid requirement after low-dose remifentanil use is unlikely to be clinically significant. TRIAL REGISTRATION NUMBER: NCT02223377.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.022 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.006 | 0.013 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.011 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".