Effects of a Very Low Dose Naloxone Addition to Intraoperative Remifentanil Infusion on Postoperative Pain in Patients Undergoing Total Hip Replacement Surgery: A Randomized Clinical Trial

Mohsen  Sabermoghaddamranjbar; Saeid Jamalie  Bastami; Alireza Sharifian  Attar; Seyed-Hossein  Khademi; Mohammad  Alipour; Mahdieh  Samei; Omid  Shahpari

doi:10.18502/jost.v10i4.17358

Mohsen Sabermoghaddamranjbar Anesthesiologist, Department of Anesthesiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Saeid Jamalie Bastami Anesthesiologist, Department of Anesthesiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Alireza Sharifian Attar Anesthesiologist, Department of Anesthesiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Seyed-Hossein Khademi Anesthesiologist, Department of Anesthesiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Mohammad Alipour Anesthesiologist, Department of Anesthesiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Mahdieh Samei Master in Immunology, Orthopedic Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
Omid Shahpari Orthopedic Surgeon, Orthopedic Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

DOI: https://doi.org/10.18502/jost.v10i4.17358

Keywords: Naloxone; Remifentanil; Pain; Randomized Controlled Trial; Hip

Abstract

Background: The objective of this study was to assess the effect of adding a very low dose of naloxone to a remifentanil infusion on postoperative pain in patients undergoing hip replacement surgery in the lateral position.

Methods: This randomized clinical trial involved 80 patients who underwent hip replacement surgery under general anesthesia and were randomly assigned into two groups through block randomization: group 1 received remifentanil at a dose of 0.3 μg/kg/minute, while group 2 received remifentanil at a dose of 0.3 μg/kg/minute with a very low dose of naloxone administered at 0.05 μg/kg/hour following injection. Postoperative pain [measured using the visual analog scale (VAS)], drowsiness caused by narcotics and analgesics in recovery, and the duration of getting out of bed were all monitored and recorded in the ward.

Results: The median [interquartile range (IQR)] of time to administration of the first sedative drug was 0 (0, 4) hours in the control group and 4 (0, 4) hours in the intervention group. The difference between the groups was statistically significant (P < 0.0001). The frequency of pain after surgery at 0, 4, and 8 hours was significantly different between the control and intervention groups (P = 0.003, P < 0.0001, and P = 0.021, respectively).

Conclusion: Based on the results, we recommend using a very low dose of naloxone along with remifentanil infusion in patients undergoing complete hip replacement surgery to reduce their pain and the need for painkillers