Effect of Remifentanil on Acute and Chronic Postsurgical Pain in Patients undergoing Cardiac Surgery

Abstract

Objectives: Our purpose was to explore the effect of remifentanil on acute and chronic postsurgical pain after cardiac surgery. Methods: Randomized controlled trials (RCTs) were retrieved in electronic databases such as PubMed, Cochrane Library, CNKI databases, Scopus, and Web of Science. A systematic review, meta-analysis, trial sequential analysis (TSA) was performed. Basic information and outcomes were extracted from the included studies. The primary outcome was chronic postsurgical pain. Secondary outcomes were scores of postsurgical pain and morphine consumption within 24 hours after cardiac surgery. Our risk of bias assessment was based on the Cochrane risk of bias tool version 2 (ROB 2.0). The overall quality of the evidence was rated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Results: Seven studies consisting of 658 patients were enrolled in the meta-analysis. A single study had a high risk of bias and two studies had a moderate risk of bias. The incidence of chronic postsurgical pain (four studies [415 patients]; RR, 1.02 [95% CI, 0.53-1.95]; P =0.95; I2=59%; TSA-adjusted CI, 0.78-1.20) and the postsurgical pain score (two studies [196 patients]; MD 0.09 [95% CI, -0.36-0.55]; P =0.69; I2=0%; TSA-adjusted CI, -0.36-0.55）were not statistically different between the two groups. However, morphine consumption (six studies [569 patients]; MD 6.94 [95% CI, 3.65-10.22]; P<0.01; I2=0%; TSA-adjusted CI, 0.00-0.49) was higher in the remifentanil group than in the control group. Discussion: There was not enough evidence to prove that remifentanil can increase the incidence of chronic postsurgical pain after cardiac surgery, but interestingly, the results tended to support a trend toward increased complications in the intervention group. However, there was moderate-certainty evidence that the use of remifentanil increases the consumption of morphine for analgesia, and more direct comparison trials are needed to inform clinical decision-making with greater confidence.