Postoperative Pain Control With a Continuous Infusion of Epidural Sufentanil in the Intensive Care Unit

Abstract

A prospective, randomized, double-blind trial was conducted to compare the analgesic actions and side effects of sufentanil continuously infused (5 micrograms/h) into the lumbar epidural space (L2-3) with those of an infusion of lumbar epidural morphine (0.5 mg/h). Forty patients admitted to an intensive care unit after elective major abdominal surgery participated over a varying period of 24-40 h. Post-operative pain was treated with an epidural bolus of either sufentanil (50 micrograms) or morphine (5 mg), followed by a continuous infusion of the same opiate. The quality of pain relief was similar in each group. The sufentanil group had a more rapid onset of analgesia. The incidence of nausea and vomiting, pruritus, and drowsiness was similar in the two groups. In spontaneously breathing patients there were no respiratory complications requiring treatment. Forced vital capacities were statistically significantly better during the first 1-4 h with sufentanil.

What Epidural Opioid Results in the Best Analgesia Outcomes and Fewest Side Effects After Surgery?

“…These isolated findings did not persist when studies were pooled overall and in subgroup analysis by type of surgery. Importantly, the use of analgesic adjuncts was similar between groups (for all but 2 trials), 23,42 as was overall total opioid consumption. Several factors may account for this lack of difference in analgesia.…”

“…41 Adjuncts to Analgesia Dyer et al 23 reported significantly higher use of supplementary IV morphine in the epidural sufentanil group compared with the epidural morphine group. In addition, despite detecting no difference in VAS pain scores, the pediatric study by Cho et al 42 showed that patients in the fentanyl group required more rescue analgesia than those receiving sufentanil (6/32 subjects compared with 0/32 subjects; P = 0.012).…”

“…There were also no differences detected by the single adult study comparing morphine to hydromorphone and 2 pediatric studies that compared the same opioids. [41][42][43] aNesthesia & aNalgesia 21 Tables and in-text Abdominal 60 5 Broekema et al 22 Tables, figures, and in-text Abdominal 59 3 Dyer et al 23 Tables, figures, and in-text Abdominal 40 4 Coppe et al 11 Tables and in-text Abdominal 46 4 Morphine vs fentanyl Valairucha et al 24 Tables and in-text Abdominal and thoracic 79 2 Vallejo et al 25 Tables, figures, and in-text Abdominal 60 3 Berti et al 26 Tables, figures, and in-text Orthopedics 30 5 Gedney and Liu 27 Tables, figures, and in-text Orthopedics 64 3 Tsueda et al 28 Tables and in-text Orthopedics 47 5 Saito et al 29 Tables, figures, and in-text Abdominal and thoracic 85 2…”

How an Audit of Epidural Patients in a Community Hospital Setting Resulted in the Development of a Formal Acute Pain Management Service

“…The adverse effects of epidural analgesics reported in the literature include nausea and vomiting, pruritus, urinary retention, ileus formation, respiratory depression, oversedation, hypotension, motor block and neurological complications (9)(10)(11)(12)(13). The dosages of EM and fentanyl, as well as the administration of EM as a bolus, would contribute to the relatively high prevalence of side effects.…”

Intra-operative epidural morphine, fentanyl, and droperidol for control of pain after spinal surgery A prospective, randomized, placebo-controlled, and double-blind trial

“…The main application route of spinal epidural opioids remains the epidural catheter with single bolus doses or continuous infusion [15,17,19,20,51,52]. The level of drug concentration in the infusion is higher than the plasma level, thus allowing selective analgesia and avoiding major complications due to systemic drug actions [46,53].…”