To predict sufentanil requirement for postoperative pain control using a real-time method

Abstract

Preoperative identification of individual sensitivity to opioid analgesics could improve the quality of postoperative analgesia. We explored the feasibility and utility of a real-time assessment of sufentanil sensitivity in predicting postoperative analgesic requirement.Our primary study included 111 patients who underwent measurements of pressure and quantitative pricking pain thresholds before and 5 minutes after sufentanil infusion. Pain intensity was assessed during the first 24-hour postsurgery, and patients who reported inadequate levels of analgesia were excluded from the study. The sufentanil requirement for patient-controlled analgesia was recorded, and a subsequent exploratory study of 20 patients facilitated the interpretation of the primary study results. In the primary study, experimental pain thresholds increased (P < 0.001) 5 minutes after sufentanil infusion, and the percent change in pricking pain threshold was positively associated with sufentanil requirement at 12 and 24 hours after surgery (β = 0.318, P = 0.001; and β = 0.335, P = 0.001). A receiver-operating characteristic curve analysis showed that patients with a change in pricking pain threshold >188% were >50% likely to require more sufentanil for postoperative pain control. In the exploratory study, experimental pain thresholds significantly decreased after the operation (P < 0.001), and we observed a positive correlation (P < 0.001) between the percent change in pricking pain threshold before and after surgery. Preoperative detection of individual sensitivity to sufentanil via the above described real-time method was effective in predicting postoperative sufentanil requirement. Thus, percent change in pricking pain threshold might be a feasible predictive marker of postoperative analgesia requirement.

Comparison of the Analgesic Effect of Sufentanil versus Fentanyl in Intravenous Patient-Controlled Analgesia after Total Laparoscopic Hysterectomy: A Randomized, Double-blind, Prospective Study

“…Opioids are useful and potent analgesics for relieving moderate-to-severe postoperative pain. Morphine, fentanyl, and sufentanil are some of the commonly used opioids for IV-PCA 2, 13, 16, 17. Morphine has been regarded as the first choice for IV-PCA and is the most commonly used and the most studied drug for IV-PCA 13.…”

“…Based on these properties, sufentanil can be considered to be appropriate and suited for IV-PCA. It is the most commonly used opioid for IV-PCA in China 17, 23, but there is relatively scarce evidence for its use in IV-PCA.…”

A Randomized Control Trial of Patient-Controlled Intravenous Analgesia (PCIA) with and Without a Background Infusion Using Sufentanil for Cesarean Section Analgesia

“…Opioids, as a kind of analgesics, can effectively and potently relieve moderate-to-severe postoperative pain, and common opioids for PCIA are morphine, sufentanil and fentanyl [10][11][12][13]. Morphine, considered the most appropriate drug for PCIA, has enjoyed the widest application and the most study [10].…”

Comparison of different sufentanil&ndash;tramadol combinations for pain relief within the first 24 hours after cesarean section: a retrospective study

“…Patient records and related information were anonymized before analysis. On receipt of IRB approval, data were compiled from a postoperative analgesic follow-up database that was maintained by the Acute Pain Service (APS) at our hospital 13 between September 2013 and March 2017. Parturients between the ages of 18 and 50 years, with an American Society of Anesthesiologists physical status score of I to III, who had undergone a CS under neuraxial anesthesia were enrolled.…”

“… 9 , 12 It has been in common use in the People’s Republic of China for postoperative pain management. 12 , 13 Because of the two components of pain following CS, somatic pain from the wound itself and visceral pain arising from the uterus, sufentanil alone is insufficient to produce the desired relief in parturients, and higher doses could lead to severe adverse reactions such as respiratory depression. 14 Tramadol, as a weak μ-opioid receptor agonist, also inhibits presynaptic noradrenaline and serotonin (5-HT) reuptake, stimulates 5-HT secretion, and shows good clinical efficacy in treating visceral pain without significant side effects.…”