Spinal Mechanisms Contribute to Analgesia Produced by Epidural Sufentanil Combined with Bupivacaine for Postoperative Analgesia

Joris, Jean; Jacob, Eric; Sessler, Daniel I.; Deleuse, Jean François J; Kaba, Abdourahmane; Lamy, Maurice

doi:10.1213/01.ane.0000082251.85534.84

Cited by 18 publications

(11 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Here, we used 10 mg of sufentanil for EDA and 5 mg of sufentanil for spinal anaesthesia as in our regular clinical practice; however, this might be a limitation of the study, because we are unaware of equipotent dosages. Furthermore, lipophilic opiate agents injected epidurally are quickly absorbed in the systemic circulation [21] and thus can also act supraspinally [22,23]. A segmental effect is suspected, however, as they lower the minimum concentration of local anaesthetics better than they do when they are given systemically [24] and they also act on temporal summation [25].…”

Section: Discussionmentioning

confidence: 99%

Effects of spinal anaesthesia versus epidural anaesthesia for caesarean section on postoperative analgesic consumption and postoperative pain

Schewe¹,

Komusin

Zinserling³

et al. 2009

European Journal of Anaesthesiology

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Effects of spinal anaesthesia versus epidural anaesthesia for caesarean section on postoperative analgesic consumption and postoperative pain

Schewe¹,

Komusin

Zinserling³

et al. 2009

European Journal of Anaesthesiology

View full text Add to dashboard Cite

show abstract

“…This synergistic argument is based upon work originally undertaken in animals [47, 48], together with subsequent studies conducted in human subjects [32–34, 49]. The human studies have tended to follow a similar research model in which the patient receives a background epidural infusion of local anaesthetic to which small patient‐controlled boluses of opioid are added, either epidurally or i.v.…”

Section: The Effect Of Administering Opioids Together With Local Anaementioning

confidence: 99%

“…A prime example of a study based on this model is that conducted by Joris et al . [49] who, by using this method, showed that consumption of sufentanil in their epidural group was half that of their i.v. group.…”

Section: The Effect Of Administering Opioids Together With Local Anaementioning

confidence: 99%

See 1 more Smart Citation

The site of action of epidurally administered opioids and its relevance to postoperative pain management

George

2006

Anaesthesia

View full text Add to dashboard Cite

Summary The use of epidurally administered opioids to control postoperative pain is a well established and widely accepted technique. However, despite this longstanding use, there is still an ongoing debate concerning the site of action of the opioids used. Some argue that analgesia is mediated by a spinal mechanism and others that a supraspinal mechanism is responsible. On close inspection of the evidence it becomes apparent that epidural opioids act predominantly spinally when administered as a bolus, and predominantly supraspinally when administered as a continuous infusion. A concentration of 10 μg.ml−1 appears to be the threshold at which epidurally administered fentanyl can elicit segmental analgesia, a value which may have significant clinical applications. The evidence supporting a synergistic relationship between epidural opioids and local anaesthetics is weak and unsupported by a plausible physiological mechanism. Thus the ‘threshold concentration’ of approximately 10 μg.ml−1 is unlikely to be lowered by co‐administering opioids with local anaesthetics.

show abstract

“…Joris et al combined epidural sufentanil administered by patient controlled analgesia (PCA) with bupivacaine to manage postoperative pain in patients underwent major abdominal surgery and demonstrated a spinal dominant mechanism. In their study, they emphasized the importance of the insertion of the epidural catheter at the appropriate level of the dermatomes involved in the surgery when lipophilic opioids are used because they are more dermatomally restricted compared to hydrophilic opioids [57]. De Cosmo et al tested a continuous epidural mixture of sufentanil (5 mcg/h) combined with two different concentration of levobupivacaine (0.125% or 0.0625%) at an infusion rate of 5 ml/h in patients underwent thoracic surgery and demonstrated that 0.125% levobupivacaine provided significantly better analgesia compared to 0.0625% levobupivacaine [58].…”

Section: Opioidsmentioning

confidence: 99%

New Drugs for Epidural Analgesia

Congedo

Sgreccia

Cosmo

2009

CDT

View full text Add to dashboard Cite

In recent years there has been a wide use of the epidural technique not only during surgery to provide anesthesia and analgesia, but also for obstetric and trauma as well as acute, chronic and cancer pain states. Nowadays there is an increase in the number of the epidural drugs. Local anesthetics and opioids are still the pharmacological agents more widely used epidurally, nevertheless other drugs from different pharmacological classes are administered as adjuvant to local anesthetics and opioids or are in various early stages of investigation. Regarding to local anesthetics, the most recent literature focuses on the new enantiomers, ropivacaine and levobupivacaine, the efficacy of which is similar to that of bupivacaine with a reduced risk of cardiotoxicity. About opioids, the other class of drugs mainly used, the debate, in the last years, concerned the physicochemical properties of morphine and of the more recent lipophilic agents, fentanyl and sufentanil, in order to explain the main differences in efficacy and safety. Other categories of agents have been investigated for epidural administration, such as alpha(2)-adrenergic agonists clonidine and dexmedetomidine. They are being used increasingly as adjuvants to local anesthetics and opioids. Ketamine and neostigmine, the more recent studied drugs for epidural use, are still under investigation and are not part of routine clinical practice.

show abstract

Spinal Mechanisms Contribute to Analgesia Produced by Epidural Sufentanil Combined with Bupivacaine for Postoperative Analgesia

Abstract: When combined with epidural bupivacaine, the sufentanil requirement was 50% less when given epidurally than IV. Epidural sufentanil thus appears to have a spinal mechanism of action.

Cited by 18 publications

References 31 publications

Effects of spinal anaesthesia versus epidural anaesthesia for caesarean section on postoperative analgesic consumption and postoperative pain

Effects of spinal anaesthesia versus epidural anaesthesia for caesarean section on postoperative analgesic consumption and postoperative pain

The site of action of epidurally administered opioids and its relevance to postoperative pain management

New Drugs for Epidural Analgesia

Contact Info

Product

Resources

About