Prevention of Opioid Induced Hyperalgesia Following Remifentanil Infusion: A Case Report

Abstract

Remifentanil, a potent µ-opioid agonist, is useful in anesthesia because of its rapid onset and short duration of action. However, the same traits that make remifentanil useful can also lead to increased pain sensation when it is discontinued. Nociceptive sensitization following opioids is termed opioid-induced hyperalgesia (OIH). Proposed preventative treatments for remifentanil-induced OIH run the spectrum of cost and feasibility. This case report will discuss the use of and rationale for readily available techniques aimed at preventing OIH. These techniques include intravenous ketamine, inhaled nitrous oxide, oral pregabalin, and gradual cessation of remifentanil infusion.