Sufentanil: Clinical use as postoperative analgesic—Epidural/intrathecal route

Abstract

Although morphine and fentanyl remain the predominant epidural opioids, sufentanil offers some unique advantages. Because of its greater lipophilicity and mu-receptor binding capacity, sufentanil has a faster onset of action and longer duration than epidural fentanyl. Compared with morphine, sufentanil has been associated with a lower incidence of side effects, particularly delayed respiratory depression. The effective doses and adverse effects profile of epidural sufentanil are relatively well understood. Ventilatory depression is minimal with both bolus and continuous administration. Rapid vascular uptake after large epidural bolus, however, has been associated with acute-onset respiratory depression and even respiratory arrest. Sufentanil is more ideally suited than morphine to continuous epidural administration. The faster onset in comparison with fentanyl may make sufentanil the ideal agent for patient-controlled epidural analgesia. The synergistic effect of combined sufentanil and low-concentration bupivacaine offers advantages over sufentanil alone. High doses of epidural sufentanil have been uniquely associated with cessation of shivering and hypothermia. As with fentanyl, the intrathecal administration of sufentanil for postoperative analgesia is limited by its short duration of action.

Postoperative analgesia with epidural opioids after cesarean section: Comparison of sufentanil, morphine and sufentanil-morphine combination

“…[5] Its delayed onset of analgesic effect[67] and late onset respiratory depression limits its widespread routine use. [8] In contrast, sufentanil is a lipid soluble drug with high receptor affinity and intense analgesia of rapid onset,[9] its only limitation being short duration of analgesia,[10] which necessitates continuous infusion. [11]…”

Epidural naloxone reduces postoperative nausea and vomiting in patients receiving epidural sufentanil for postoperative analgesia

“…9 Epidural sufentanil, when compared with morphine, has been associated with a lower incidence of delayed respiratory depression. 10 However, the incidence of PONV has remained high in patients administered epidural sufentanil. 11 -13 Previous studies reported that small doses of the opioid antagonist naloxone administered i.v.…”

Intrathecal Opioid Conversions: the Importance of Lipophilicity

“…Glass reported relative lipid solubilities for opioids: morphine, 1; hydromorphone, 1.4; meperidine, 28; methadone, 82; fentanyl, 580; and sufentanil, 1280. (1) The hydrophilicity (or lipophilicity) of a drug is a significant determinant of duration of action (and onset of action) when the drug is delivered intrathecally. Morphine, hydromorphone, and meperidine are all poorly lipid soluble.…”