Resident Duty Hours: Enhancing Sleep, Supervision, and Safety – Institute of Medicine Carotid endarterectomy using single injection posterior cervical paravertebral block.
Pre-treatment with morphine does not prevent the development of remifentanil-induced hyperalgesia. [Can J Anaesth. 2008] – PubMed Result
Interesting. This study took 2 groups of children undergoing scoliosis surgery under remifentanil, starting dose well within the usual range. One group received morphine (0.15mg/kg) prior to the remi, the other group saline. The group which received the morphine did NOT have decreased post-operative morphine requirements. Instead, this group trended towards increased requirements. All patients who were changed from morphine to hydromophone were also in the morphine group.
The discussion has a nice review of the topic, noting similar findings (or failure, rather) when fentanyl was used as the pretreating agent.
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