Low-dose buprenorphine infusion to prevent postoperative hyperalgesia in patients undergoing major lung surgery and remifentanil infusion: a double-blind,

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Low-dose buprenorphine infusion to prevent postoperative hyperalgesia in patients undergoing major lung surgery and remifentanil infusion: a double-blind, randomized, active-controlled trial Marco Mercieri, Stefano Palmisani, Roberto A. De Blasi, Antonio D'Andrilli, Alessia Naccarato, Barbara Silvestri, Sara Tigano, Domenico Massullo, Monica Rocco, Roberto Arcioni British Journal of Anaesthesia Volume 119, Issue 4, Pages 792-802 (October 2017) DOI: 10.1093/bja/aex174 Copyright © 2017 The Author(s) Terms and Conditions

Fig 2 Kaplan–Meier plot showing how the mean time from extubation to first rescue dose was longer in the patients treated with buprenorphine than in those treated with morphine. At 30 min postoperatively the hazard ratio was 2.67 (1.27–5.64) (P=0.009 by Cox-proportional hazard model). British Journal of Anaesthesia 2017 119, 792-802DOI: (10.1093/bja/aex174) Copyright © 2017 The Author(s) Terms and Conditions

Fig 3 Bubble chart showing that fewer patients in the buprenorphine group developed an area of hyperalgesia (number of bubbles), and the mean extension of these areas was significantly smaller (dimension of bubbles). Each circle represents a single patient and his/her localization and measurement of peri-incisional mechanic hyperalgesic area. The size of each circle is proportional to the measured area. British Journal of Anaesthesia 2017 119, 792-802DOI: (10.1093/bja/aex174) Copyright © 2017 The Author(s) Terms and Conditions

Fig 4 Bar histograms showing increased postoperative tactile threshold 1 cm from the surgical incision in the buprenorphine group with respect to control. Normalized and log-transformed values for tactile thresholds (x-axis); number of patients (y-axis). British Journal of Anaesthesia 2017 119, 792-802DOI: (10.1093/bja/aex174) Copyright © 2017 The Author(s) Terms and Conditions

Fig 5 The 48 h postoperative pain was significantly lower in the treated group compared to the control group both at rest and during coughing (*P<0.05 at rest, °P<0.05 during coughing). VAS, visual analogue scale. British Journal of Anaesthesia 2017 119, 792-802DOI: (10.1093/bja/aex174) Copyright © 2017 The Author(s) Terms and Conditions

Fig 6 Diagram showing the technique used to define hyperalgesic and allodynic areas. Identified polygonal areas were divided in smaller polygons to simplify calculation. British Journal of Anaesthesia 2017 119, 792-802DOI: (10.1093/bja/aex174) Copyright © 2017 The Author(s) Terms and Conditions

Fig 1 Flow diagram of the progress through the phases of trial. British Journal of Anaesthesia 2017 119, 792-802DOI: (10.1093/bja/aex174) Copyright © 2017 The Author(s) Terms and Conditions