Low-dose sufentanil dœs not potentiate intra-thecal morphine for perioperative analgesia after major colorectal surgery

Abstract

Purpose: Both intrathecal sufentanil (ITS) and intrathecal morphine (ITM) improve analgesia in obstetrical or cardiac procedures. From a pharmacokinetic standpoint, combining these two opioids may improve perioperative analgesia. We performed a prospective randomized double-blind study to compare the analgesic efficacy of ITM alone vs a mixture of a low dose of ITS plus ITM for perioperative pain relief in colorectal surgery. Methods:Eighty adult patients undergoing colorectal surgery were randomly allocated to receive either 0.4 mg ITM alone or 10 µg ITS plus 0.4 mg ITM before general anesthesia. Intraoperative intravenous sufentanil consumption, postoperative morphine consumption delivered with a patient controlled analgesia device, pain scores, patient satisfaction and adverse effects were recorded for the first 48 hr postoperatively. Results:No differences were observed between groups with respect to intraoperative sufentanil consumption (39 ± 23 µg in group ITM and 40 ± 25 µg in group ITS plus ITM, P = 0.85) and in postoperative morphine consumption in postanesthesia care unit (6 ± 5 mg vs 6 ± 5 mg, P = 0.59), at 24 hr (26 ± 17 vs 24 ± 15 mg, P = 0.59) and at 48 hr (47 ± 31 vs 44 ± 22 mg, P = 0.58). Similarly, no differences were observed in regards to pain relief, patient satisfaction and incidence of adverse effects. Conclusions:These results do not support the addition of 10 µg ITS to 0.4 mg ITM for colorectal surgery, as low dose sufentanil does not improve intraoperative and postoperative analgesia in this setting. post-anesthésiques (6 ± 5 mg vs 6 ± 5 mg, P = 0,59), à 24 h (26 ± 17 vs 24 ± 15 mg, P = 0,59) et à 48 h (47 ± 31 vs 44 ± 22 mg, P = 0,58

Preoperative preemptive drug administration for acute postoperative pain: A systematic review and meta‐analysis

“…The fact that opioid analgesics have many unwanted side-effects such as nausea, vomiting, urinary retention, sedation, respiratory depression, drug dependence, dizziness and dry mouth (Higgins et al, 1994;Liukkonen et al, 2002;Akca et al, 2004;Horattas et al, 2004) tends to reduce their appeal further by complicating recovery and lengthening hospitalization (Higgins et al, 1994). Nevertheless, combinations of analgesics with different pharmacokinetic properties, either two opioids or an opioid with another class of analgesic agent, may increase analgesic effectiveness while reducing the worst of the side-effects (Culebras et al, 2007).…”

Dor crônica pós-cesariana. Influência da técnica anestésico-cirúrgica e da analgesia pós-operatória

“…Sufentanil was an important intraoperative adjuvant because it allowed the use of spinal anesthesia for cesarean section with small doses of local anesthetic (8 and 10 mg of bupivacaine). Culebras et al 24 found that low doses of sufentanil did not potentiate the effect of intrathecal morphine used for postoperative analgesia after colorectal surgery 24 .…”

Avaliação de dor crônica pós-cesariana. Influência da técnica anestésico-cirúrgica e da analgesia pós-operatória

“…O sufentanil foi importante adjuvante no intra-operatório, pois permitiu realização de raquianestesia para cesariana com doses pequenas de anestésico local (8 e 10 mg de bupivacaína). Culebras et al (2007) observaram que baixas doses de sufentanil não potencializaram o efeito da morfina intratecal, usado na analgesia pós-operatória, em cirurgia colo-retal (85) .…”