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

Youssef, Nayer; Orlov, David; Alie, Tristan; Chong, Matthew; Cheng, Ji; Thabane, Lehana; Paul, James

doi:10.1213/ane.0000000000000377

Cited by 45 publications

(17 citation statements)

References 57 publications

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“…Meta-analyses have reported the benefits of using sufentanil, especially with respect to adverse effects. However, nausea, vomiting, and respiratory depression have also been reported as a result of overcompensation (Pöpping et al, 2012; Youssef et al, 2014). A multimodal analgesia that could enhance analgesia and reduce the requirement for opioids would be productive.…”

Section: Discussionmentioning

confidence: 99%

The Opioid-Sparing Effect of Perioperative Dexmedetomidine Plus Sufentanil Infusion during Neurosurgery: A Retrospective Study

Su¹,

Ren

Zhang

et al. 2016

Front. Pharmacol.

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Background: Approximately 60% of patients experience moderate-to-severe pain after neurosurgery, which primarily occurs in the first 24–72 h. Despite this, improved postoperative analgesia solutions after neurosurgery have not yet been devised. This retrospective study was conducted to evaluate the effect of intra- and post-operative infusions of dexmedetomidine (DEX) plus sufentanil on the quality of postoperative analgesia in patients undergoing neurosurgery.Methods: One hundred and sixty-three post-neurosurgery patients were divided into two groups: Group D (DEX infusion at 0.5 μg·kg−1 for 10 min, then adjusted to 0.3 μg·kg−1·h−1 until incision suturing) and Group ND (no DEX infusion during surgery). Patient-controlled analgesia was administered for 72 h after surgery (Group D: sufentanil 0.02 μg·kg−1·h−1 plus DEX 0.02 μg·kg−1·h−1, Group ND: sufentanil 0.02 μg·kg−1·h−1) in this retrospective study. The primary outcome measure was postoperative sufentanil consumption. Hemodynamics, requirement of narcotic, and vasoactive drugs, recovery time and the incidence of concerning adverse effects were recorded. Pain intensity [Visual Analogue Scale (VAS)], Ramsay sedation scale (RSS) and Bruggemann comfort scale (BCS) were also evaluated at 1, 4, 8, 12, 24, 48, and 72 h after surgery.Results: Postoperative sufentanil consumption was significantly lower in Group D during the first 72 h after surgery (P < 0.05). Compared with Group ND, heart rate (HR) in Group D was significantly decreased from intubation to 20 min after arriving at post anesthesia care unit (PACU), while mean arterial pressure (MAP) in Group D was significantly decreased from intubation to 5 min after arriving at PACU (P < 0.05). The intraoperative requirements for sevoflurane, remifentanil, and fentanyl were approximately 35% less in Group D compared with Group ND. VAS at rest at 1, 4, and 8 h and with cough at 12, 24, 48, and 72 h after surgery were significantly lower in Group D (P < 0.05). Compared with Group ND, patients in Group D showed lower levels of overall incidence of tachycardia, hypertension, nausea, and vomiting (P < 0.05). There were no significant differences between the two groups in terms of baseline clinical characteristics, recovery time, RSS, and BCS (P > 0.05).Conclusions: DEX (0.02 μg·kg−1·h−1) plus sufentanil (0.02 μg·kg−1·h−1) could reduce postoperative opioid consumption and concerning adverse adverse effects, while improving pain scores. However, it did not influence RSS and BCS during the first 72 h after neurosurgery.

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Section: Discussionmentioning

confidence: 99%

The Opioid-Sparing Effect of Perioperative Dexmedetomidine Plus Sufentanil Infusion during Neurosurgery: A Retrospective Study

Su¹,

Ren

Zhang

et al. 2016

Front. Pharmacol.

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“…Despite differences in pharmacokinetics and pharmacodynamics between opioids, 30 a recent meta-analysis by Youssef et al 31 demonstrated that the incidence of pruritus with neuraxial fentanyl is as high as that with neuraxial morphine. The incidence of pruritus in nonobstetric surgery patients after intrathecal morphine ranges from 15% to 70% 32-34 and after intrathecal fentanyl or sufentanil, from 53% to 79%.…”

Section: Discussionmentioning

confidence: 99%

Prophylactic Ondansetron for the Prevention of Intrathecal Fentanyl- or Sufentanil-Mediated Pruritus

Prin

Guglielminotti²,

Moitra

et al. 2016

Anesthesia &Amp; Analgesia

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“…This could result in a concentration gradient in the cerebrospinal fluid with concurrent alterations in the rostral spread, resulting in increased systemic side effects if similar doses of morphine are used in a thoracic relative to lumbar epidural [43]. Late respiratory depression has been found to occur up to 24 h [44] [27] Sedation ++ [38,40], hypotension + [38] *: -= no reported neurotoxicity; + = at least some reported neurotoxicity or inconclusive data; ++ = multiple reports, neurotoxicity probable; +++ = multiple reports, almost certainly neurotoxic **: -= no reported side effects; + = mild effect; ++ = moderate effect; +++ = profound effect after an epidural dose. The incidence for delayed respiratory depression was found to be 0-2.8% [45], however a clear definition of respiratory depression is missing in the literature [45,46].…”

Section: Systemic Response and Respiratory Depressionhydrophilic Opioidsmentioning

confidence: 99%

Safety of epidural drugs: a narrative review

Zuylen

Hoope

Bos

et al. 2019

Expert Opinion on Drug Safety

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Introduction: Epidural analgesia is a popular approach to postoperative and labor pain. Neurotoxicity and drug-specific systemic side effects can occur after epidural administration. As an increasing number of epidural drugs are studied and clinically applied, drug efficacy and safety evaluation are crucial. Areas covered: In this narrative review, the authors provide a thorough overview on the safety of the most widely used epidural drugs, focusing on potential neurotoxicity, side effects, and complications in the adult, non-pregnant population. A combined text and MeSH heading search strategy was used to identify relevant publications. Expert opinion: The search for the ideal epidural medication has resulted in a surplus of drug combinations with extensive heterogeneity amongst studies, while the value of investigating these is not always evident. Epidural drugs pose a potential threat of neurotoxicity and other side effects. Consequently, we should pursue safe epidural drug administration to patients and refrain from drugs with minimal proven benefit. Also, studies should compare epidural with systemic application. Because why use a drug epidurally, which can be safely used systemically? Future research should focus on providing solid evidence regarding efficacy of epidural analgesia compared to new and already existing modalities and optimizing presently used medicinal regimens.

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

Cited by 45 publications

References 57 publications

The Opioid-Sparing Effect of Perioperative Dexmedetomidine Plus Sufentanil Infusion during Neurosurgery: A Retrospective Study

The Opioid-Sparing Effect of Perioperative Dexmedetomidine Plus Sufentanil Infusion during Neurosurgery: A Retrospective Study

Prophylactic Ondansetron for the Prevention of Intrathecal Fentanyl- or Sufentanil-Mediated Pruritus

Safety of epidural drugs: a narrative review

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