Epidural fentanyl and sufentanil for intra- and postoperative analgesia

Abstract

In a double-blind, randomized study the efficacies of concentrated fentanyl and sufentanil injections as intraoperative epidural analgesics were compared. Also, the equivalent dose of fentanyl and sufentanil administered by continuous infusion during the first 24 h postoperatively, expressed in analgesia and also considering the side-effects was determined. 53 Patients undergoing elective thoracotomy, aortic surgery and bowel surgery were randomized and treated double-blind with fentanyl 0.250 mg/ml or sufentanil 0.05 mg/ml. Preoperatively, 0.5-1 ml study medication was administered, followed by increments of 0.2-0.5 ml during surgery guided by heart rate and systolic blood pressure. Postoperatively, study medication diluted in 1.25 mg/l bupivacaine was administered by continuous epidural infusion. The infusion rate was adjusted to optimize analgesia. Dose, heart rate and systolic blood pressure were measured intra- and postoperatively. Pain, sedation, nausea and pruritus were assessed on a 10 cm visual analogue scale. There were no differences in required volume of study medication, heart rate and systolic blood pressure nor in the parameters assessed postoperatively. Administered doses were 27.5 micrograms/h fentanyl and 5.5 micrograms/h sufentanil. It was concluded that 0.250 mg/ml (0.74 mumol/ml) fentanyl is clinically equivalent to 0.050 mg/ml (0.13 mumol/ml) sufentanil.

Comparison of the Effects of Sufentanil and Fentanyl Intravenous Patient Controlled Analgesia after Lumbar Fusion

“…Despite the sufentanil induced release of histamine from basophils, the nature of post-opioid pruritus does not appear to be directly related to this phenomenon; naloxone has been reported to cause the gradual subsidence of post-opioid pruritus, but at a much slower rate than other side effects3,14,17). Previous comparative studies on the incidence of pruritus after fentanyl or sufentanil via IV or epidural PCA found no significant difference between the two drugs6,9,16,23). Headache and hypotension occurred in 1 case each in their study groups (4.8%).…”

“…Some studies have reported sufentanil has a lower tendency than fentanyl to induce nausea and vomiting9,12,17,23). whereas other have reported it has a greater tendency6,16).…”

Comparison of post operative analgesia with Fentanyl and Sulfentanil via epidural route in thoracic and upper abdominal surgeries

“…Sufentanil is proven to be more potent than fentanyl with less sedation. [5] Potency ratio of sufentanil/fentanyl has been reported to be 5-7:1 for intravenous administration, but we cannot extrapolate this data in case of epidural route. As lipid solubility of sufentanil id=s higher in case of intravenous route this will result into higher penetration of BBB resulting into higher ratio, while in case of epidural route, higher lipid solubility results into larger uptake of it into epidural fat, which ultimately results into decreased potency ratio in comparison to intravenous route.…”

“…Opioids like fentanyl and sufentanil have been successfully used for postoperative analgesia by epidural route. [2][3][4][5] Advantages includes avoidance of systemic toxicity, easy supplementation by catheter, early mobilization and low failure rate. Opioids since their first use in the epidural and subarachnoid space, have become the mainstay of postoperative pain relief.…”

“…[6] Various studies have compared fentanyl and sufentanil in major abdominal surgeries, caesarean section for postoperative analgesia by epidural route. [4][5][6][7] So keeping these aspects in mind, we decided to compare and contrast sufentanil with the time tested and widely used opioid fentanyl for the relief of pain after thoracic and upper…”