Safety and effectiveness of adding fentanyl or sufentanil to spinal anesthesia: systematic review and meta-analysis of randomized controlled trials

Fonseca, Neuber Martins; Guimarães, Gabriel Magalhães Nunes; Pontes, João Paulo Jordão; Azi, Liana Maria Torres de Araujo; Oliveira, Ricardo de Ávila

doi:10.1016/j.bjane.2021.10.010

Cited by 15 publications

(14 citation statements)

References 85 publications

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“…In our study, SBP, DBP, and heart rates across group were slightly decreased after analgesia when compared with values before analgesia, with group A having significantly lower values when compared with B1 and B2 groups, suggesting that genotyping and individualized doses effectively reduced cardiac excitability when suppressed by sufentanil. However, in a previous meta-analysis, the incidence of respiratory depression (defined as a respiratory rate <8-10 and pulse oximeter oxygen saturation <90%) was very low, thus meaningful conclusions were difficult to ascertain [30]. In our study, we observed significant decreases in respiratory rates and oxygen saturation levels immediately after anesthesia across groups.…”

Section: Dong Et Al Reported That the Rs2242480 Snp In Hancontrasting

confidence: 47%

“…In addition to the inhibitory effects on cardiovascular and respiratory systems, sufentanil-induced gastrointestinal adverse effects, skin pruritus, and urinary retention are frequently observed side effects [30,37,38]. Salem et al reported that some women with epidural sufentanil analgesia during labor suffered severe nausea and pruritus drug administration [39].…”

Section: Discussionmentioning

confidence: 99%

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Cytochrome P4503A4 gene polymorphisms guide safe sufentanil analgesic doses in pregnant Chinese mothers: a multicenter, randomized, prospective study

Shu,

Yan,

et al. 2023

Pharmacogenetics and Genomics

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Background Sufentanil and ropivacaine when used as epidural anesthetics effectively reduce maternal pain during labor. From previous reports, rs2242480 single nucleotide polymorphisms (SNPs) can alter sufentanil metabolism, which affects analgesic efficacy. Methods We randomly divided 573 eligible mothers into groups A and B (in a 1 : 3 ratio). The control group (group A) was given sufentanil at the usual 0.5 mg/L-1 dose + 0.15% ropivacaine hydrochloride mixture in 10 ml. The sufentanil dose given to the intervention group (group B) was determined by genotype: the GA and AA genotype group (group B1) was given 87.6% (design based on previous study results) of the usual sufentanil clinical dose (0.438 mg/L-1 sufentanil + 0.15% ropivacaine hydrochloride mixture in 10 ml) and the GG genotype group (group B2) was given the same dose as group A. Efficacy indicators consisting of maternal vital signs, obstetric transfer, neonatal prognostic indicators, and adverse effects were recorded before and after analgesia across groups. Results Visual analog scale scores after analgesia across groups were significantly different from scores before analgesia, showing that analgesic effects across groups were effective. No significant differences were observed in efficacy, obstetric transfer, and neonatal prognosis indicators between groups. In comparison to groups B1 and B2, group A showed more markedly suppressed cardiovascular and respiratory effects, and also a higher incidence of negative side effects such as vomiting and urinary retention. Conclusion We confirmed that individualizing sufentanil doses based on maternal genotypes increased safety and success rates for women during childbirth.

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Section: Dong Et Al Reported That the Rs2242480 Snp In Hancontrasting

confidence: 47%

Section: Discussionmentioning

confidence: 99%

Cytochrome P4503A4 gene polymorphisms guide safe sufentanil analgesic doses in pregnant Chinese mothers: a multicenter, randomized, prospective study

Shu,

Yan,

et al. 2023

Pharmacogenetics and Genomics

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“…Fentanyl, when given intrathecally, extends the duration and scope of sensory block; studies comparing intrathecal ‘LA with opioids’ to ‘LA alone’ (either as a single shot or continuous spinal anaesthesia) showed improved pain scores and reduced need for rescue analgesia in the ‘opioid-based’ groups. [ 6 ] This synergistic effect of LA and opioids has been effectively used in numerous abdominal surgeries. [ 1 , 2 , 3 , 6 ] Our results align with the above studies.…”

Section: Discussionmentioning

confidence: 99%

Comparison of block characteristics and outcomes in opioid-free and opioid-based thoracic continuous spinal anaesthesia in patients undergoing major abdominal surgery: A double-blinded randomised controlled trial

Sangadala,

Talawar,

Tripathy

et al. 2024

Indian Journal of Anaesthesia

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Background and Aims: Thoracic continuous spinal anaesthesia (TCSA) is emerging as the sole anaesthetic for major abdominal surgery due to its better perioperative outcomes. This study was designed to evaluate block characteristics and outcomes in ‘opioid-free’ and ‘opioid-based’ TCSA. Methods: After ethical approval, trial registration and written informed consent, 50 adult patients undergoing major abdominal surgery were randomised into ‘opioid-free’ (bupivacaine alone) and ‘opioid-based’ (bupivacaine with fentanyl) groups. After confirmation of T4-L1 dermatome level of spinal anaesthesia, sedation by intravenous (IV) midazolam (0.02–0.05 mg/kg), ketamine (0.25 mg/kg) and dexmedetomidine (bolus dose of 1 µg/kg IV over 10 min followed by 0.2–0.7 µg/kg/h infusion) were started. The primary outcome measured was postoperative pain scores for 72 h in both groups. The secondary objectives were rescue opioid requirement, and the dose of bupivacaine required to achieve T4 level. Data were compared using the two-sided Student t-test, Mann-Whitney and Fisher’s exact tests. Results: The ‘opioid-based’ group performed significantly better compared with the ‘opioid-free’ group concerning pain scores at rest at 0 h (P = 0.023), 18 h (P = 0.023) and 24 h (P = 0.016) postoperatively, decreased intrathecal bupivacaine requirement [(induction (P = 0.012) and maintenance (P = 0.031)], postoperative rescue fentanyl requirement (P = 0.018) and patient satisfaction (P = 0.032) at the cost of increased postoperative nausea and vomiting (P = 0.049). Conclusion: The ‘opioid-based’ TCSA provided better postoperative analgesia with significantly lesser postoperative pain scores when compared to the ‘opioid-free’ group in patients undergoing major abdominal surgery.

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“…Through decreasing the responsiveness of the brainstem respiratory centers and causing the increases in carbon dioxide tension, intravenous routes of SUF were revealed to dose-dependently produce respiratory depression, which should not be a reason to abandon spinal SUF as recommended by a previous study. 28 Recently, NAL considered to be a more ideal and safer analgesic, and it has been widely used in pediatric and gynecological surgery, with a ceiling effect on respiratory depression. 29 A previous research demonstrated that DEX added to NAL PCIA enhanced the analgesic effects, attenuated the postoperative pain, and reduced the stress response after pediatric tonsillectomy adenoidectomy.…”

Section: Discussionmentioning

confidence: 99%

Patient‐controlled intravenous administration of dexmedetomidine with nalbuphine versus sufentanil for post cesarean delivery analgesia: A retrospective observational study

Zheng²,

Shi

et al. 2023

The Kaohsiung J of Med Scie

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This retrospective observational study aims to investigate the patient-controlled intravenous analgesia (PCIA) of dexmedetomidine (DEX) with nalbuphine (NAL) versus sufentanil (SUF) for post-cesarean delivery management. A total of 300 women were evaluated who underwent cesarean section surgery with combined spinalepidural anesthesia. After surgery, all patients were connected to a patient-controlled analgesia pump. The PCIA protocol was programmed with 0.11 μg/kg/h DEX in combination with 0.03 μg/kg/h SUF in Group I (n = 150) or 0.11 μg/kg/h DEX in combination with 0.03 mg/kg/h NAL in Group II (n = 150). There was no significant difference in incision pain and sedation level between the two groups within 48 h after the surgery assessed by visual analog scale (VAS) and Ramsay sedation scale, respectively. However, at 2, 6, 12, and 24 h after surgery, visceral pain at rest and at mobilization was alleviated in the Group II as compared with the Group I with lower VAS scores. Moreover, fewer adverse reactions were found in the Group II when compared with Group I, including postpartum respiratory depression, nausea/vomiting, urinary retention, and cardiovascular events. Overall, there was an increased patient satisfaction in the Group II as compared with the Group I. Based on the results of this study, it seems that adding NAL to PCIA with DEX, as compared to SUF with DEX, have an effect on reducing the intensity of visceral pain after cesarean section with less adverse reactions and higher patient satisfaction.

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Safety and effectiveness of adding fentanyl or sufentanil to spinal anesthesia: systematic review and meta-analysis of randomized controlled trials

Cited by 15 publications

References 85 publications

Cytochrome P4503A4 gene polymorphisms guide safe sufentanil analgesic doses in pregnant Chinese mothers: a multicenter, randomized, prospective study

Cytochrome P4503A4 gene polymorphisms guide safe sufentanil analgesic doses in pregnant Chinese mothers: a multicenter, randomized, prospective study

Comparison of block characteristics and outcomes in opioid-free and opioid-based thoracic continuous spinal anaesthesia in patients undergoing major abdominal surgery: A double-blinded randomised controlled trial

Patient‐controlled intravenous administration of dexmedetomidine with nalbuphine versus sufentanil for post cesarean delivery analgesia: A retrospective observational study

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