Background: Chronic thoracic pain after cardiac surgery is prevalent (11 to 56%) and may affect patients' physical and mental health status. Despite its favorable pharmacokinetic and pharmacodynamic properties, high doses of remifentanil administered during surgery are reported to cause acute postoperative pain and increased requirements for analgesics. Recently, an association between remifentanil use and the incidence of chronic thoracic pain in the long term was also reported. Our objective is to investigate the influence of the intraoperative remifentanil on chronic postoperative pain in a prospective randomized controlled trial. Methods/design: In this prospective, randomized, single-blind clinical trial, all patients (N =126) between 18 and 85 years undergoing cardiac surgery via sternotomy receive a continuous infusion of propofol together with intermittent intravenous fentanyl at predetermined times perioperatively. Patients are randomized to receive either an additional continuous infusion of remifentanil (0.15 μg<sup>-1</sup>kgIBW<sup>-1</sup> min<sup>-1</sup>) or additional fentanyl (200 to 500 μg) as needed during surgery. Discussion: Chronic thoracic pain is prevalent after cardiac surgery, and research is needed to minimize the risk of chronic persistent postoperative pain, which is an invalidating, long-term complication of surgery. The objective of this trial is to determine the influence of perioperative remifentanil on long-term pain outcomes for cardiac patients in a prospective randomized trial. The results may be used to optimize perioperative analgesia techniques and, thereby, improve quality of life after cardiac surgery. Trial registration: NCT02031016, on 13 December 2013.

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Department of Intensive Care

de Hoogd, S, Ahlers, S.J.G.M, van Dongen, E.H.P.A, Tibboel, D, Dahan, A, & Knibbe, C.A.J. (2014). Remifentanil versus fentanyl during cardiac surgery on the incidence of chronic thoracic pain (REFLECT): Study protocol for a randomized controlled trial. Trials. doi:10.1186/1745-6215-15-466