The following is a summary of “Effect of Remifentanil on Acute and Chronic Postsurgical Pain in Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-analysis,” published in the March 2024 issue of Pain by Zhang et al.

Researchers conducted a retrospective investigation to analyze remifentanil’s impact on acute and chronic postsurgical pain following cardiac surgery.

They retrieved electronic databases such as PubMed, Cochrane Library, China National Knowledge Internet databases, Scopus, and Web of Science, which were RCTs. Systematic review, meta-analysis, and trial sequential analysis (TSA) were conducted. Basic information and outcomes were extracted from the included studies. The primary outcome focused on chronic postsurgical pain, with secondary outcomes including scores of postsurgical pain and morphine consumption within 24 hours after cardiac surgery. The risk of bias (ROB) assessment relied on the Cochrane ROB tool version 2. The overall quality of evidence was rated by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system.

The results showed that for 658 patients, one study exhibited a high ROB, while two had a moderate ROB. Incidence of chronic postsurgical pain (4 studies [415 patients]) was not significantly different between the groups (risk ratio: 1.02 [95% CI: 0.53 to 1.95]; P=0.95; I² = 59%; TSA-adjusted CI: 0.78 to 1.20). Similarly, the postsurgical pain score (2 studies [196 patients]) did not differ notably between the groups (mean difference: 0.09 [95% CI: −0.36 to 0.55]; P=0.69; I² = 0%; TSA-adjusted CI: −0.36 to 0.55). However, morphine consumption (6 studies [569 patients]) was higher in the remifentanil group compared to the control group (mean difference: 6.94 [95% CI: 3.65 to 10.22]; P<0.01; I² = 0%; TSA-adjusted CI: 0.00 to 0.49).

They concluded that remifentanil may increase morphine use, but its link to chronic pain remains unclear; further studies are needed.

Source: journals.lww.com/clinicalpain/abstract/2024/03000/effect_of_remifentanil_on_acute_and_chronic.7.aspx