Epidural sufentanil versus intramuscular buprenorphine for postoperative analgesia

Donadoni, R.; Rolly, G

doi:10.1111/j.1365-2044.1987.tb05222.x

Cited by 15 publications

(5 citation statements)

References 10 publications

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“…In a study of 60 patients who were randomly assigned either i.m. buprenorphine (0·3 mg) or epidural sufentanil (50 μg) following orthopaedic surgery, buprenorphine produced less analgesia over the first 2 h, but greater analgesia from 2 to 8 h (Figure S17) . In only one identified study, did the analgesic effect of buprenorphine not attain that produced by morphine.…”

Section: Commentmentioning

confidence: 99%

The clinical analgesic efficacy of buprenorphine

et al. 2014

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SUMMARYWhat is known and objective: Based on in vitro assays and select animal models, buprenorphine is commonly called a 'partial agonist'. An implication is that it should produce less analgesic effect in humans than so-called 'full agonists' such as morphine or fentanyl. However, buprenorphine has a multimechanistic pharmacology, and thus partial agonism at a specific receptor is not particularly relevant to its overall analgesic action. We review published clinical trials that directly compared the magnitude of buprenorphine's analgesic effect to analgesics commonly considered full agonists. Comment: Due to different signal transduction pathways, a drug can be a full agonist on one endpoint and a partial agonist on another. Therefore, we limited the present review to buprenorphine's analgesic effect. What is new and conclusion: Twenty-four controlled clinical trials were identified, plus a case report and dose-response curve. Based on complete or comparable pain relief, in buprenorphine had full clinical analgesic efficacy in 25 of the 26 studies. WHAT IS KNOWN AND OBJECTIVEBuprenorphine is a centrally acting analgesic. It was first synthesized in 1966 and has been demonstrated to have antinociceptive and analgesic activity 1,2 against a wide variety of pains, including nociceptive, musculoskeletal, neuropathic and cancer-related 3 pains. Buprenorphine's oral absorption is limited, but its bioavailability is greater by other routes, and its physiochemical properties make it particularly well suited for use in transdermal 'patch' formulations. 4 Buprenorphine's mechanism of action has previously been described 5-8 as has its clinical characteristics that warrant its consideration as a first-line analgesic.9 However, the basis for its classification as a 'partial agonist' has undergone much less scrutiny. We focus on the single issue of whether buprenorphine produces the same or different clinical analgesic efficacy as analgesics considered to be full agonists.When a drug is characterized as a 'full' or 'partial' agonist based primarily on in vitro assays, it can confuse the related, but distinct, pharmacologic principles of affinity and intrinsic activity (properties at the receptor level) and efficacy (manifested at a particular endpoint). 'Affinity' is the thermodynamically driven chemical attraction between a drug and a receptor 10 ; 'intrinsic activity' is the biological stimulus imparted by a drug to a receptor 11 ; and 'efficacy' relates to the level of drug-induced effect in a given application. Unfortunately, in certain contexts, the term 'efficacy' has sometimes been loosely used as if it is a fundamental property of a drug, rather than as being situation (endpoint) dependent. We use the term 'clinical efficacy' in order to be clear. As the definition of a partial agonist involves an inability to produce the same level of effect as some reference drug in a given situation, it is only meaningful in the context of a reference compound or drug. This review summarizes published comparisons of buprenorphi...

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Section: Commentmentioning

confidence: 99%

The clinical analgesic efficacy of buprenorphine

et al. 2014

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“…. Spinal sufentanil to promote postoperative analgesia has been widely used both in adults and children 10,11 . As compared to morphine, spinal sufentanil produces a deeper and faster analgesia 12 ; however, it has a shorter duration and may lead to respiratory depression 13,14 .…”

Section: Resultsmentioning

confidence: 99%

“…(Tabelas III e IV). A administração espinhal do sufentanil com o propósito de promover analgesia pós-operatória tem sido bem conhecida em adultos e crianças 10,11 . Comparado à morfina, o sufentanil subaracnóideo produz analgesia mais intensa e mais rá-pida 12 ; entretanto, a sua duração é menor e a depressão respiratória, após o seu emprego, pode surgir como seu principal efeito colateral 13,14 .…”

Section: Métodounclassified

Avaliação do estado ácido-básico materno com o uso de sufentanil por via subaracnóidea em diferentes doses para cesarianas e suas repercussões sobre os recém-nascidos

Castro¹,

Serafim²,

Côrtes³

et al. 2003

Rev. Bras. Anestesiol.

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“…[6][7][8][9][10][11][12][13] Additional RCTs comparing single-injection epidural opioids with intravenous opioids report inconsistent findings regarding respiratory depression, respiratory failure, somnolence, or sedation (Category A2-E evidence). [6][7][8][9][10][11][12][13] Additional RCTs comparing single-injection epidural opioids with intravenous opioids report inconsistent findings regarding respiratory depression, respiratory failure, somnolence, or sedation (Category A2-E evidence).…”

Section: Route Of Administrationmentioning

confidence: 99%

Practice Guidelines for the Prevention, Detection, and Management of Respiratory Depression Associated with Neuraxial Opioid Administration

2016

Anesthesiology

100

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The American Society of Anesthesiologists Committee on Standards and Practice Parameters and the Task Force on Neuraxial Opioids and the American Society of Regional Anesthesia and Pain Medicine present an updated report of the Practice Guidelines for the Prevention, Detection, and Management of Respiratory Depression Associated with Neuraxial Opioid Administration. Supplemental Digital Content is available in the text.

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Epidural sufentanil versus intramuscular buprenorphine for postoperative analgesia

Abstract: SummaryEpidural sufentanil SO pg MUS

Cited by 15 publications

References 10 publications

The clinical analgesic efficacy of buprenorphine

The clinical analgesic efficacy of buprenorphine

Avaliação do estado ácido-básico materno com o uso de sufentanil por via subaracnóidea em diferentes doses para cesarianas e suas repercussões sobre os recém-nascidos

Practice Guidelines for the Prevention, Detection, and Management of Respiratory Depression Associated with Neuraxial Opioid Administration

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