Intrathecal Sufentanil for Intraoperative and Postesophagectomy Pain Relief
Intrathecal Sufentanil for Intraoperative and Postesophagectomy Pain Relief
Objectives: The present study compares the analgesic properties of intrathecal (IT group) and intravenous (IV group) sufentanil in postoperative pain relief.
Methods: This randomized, single blinded study was performed on patients awaiting transhiatal esophagectomy. The patients were randomly allocated to receive sufentanil intrathecally or intravenously. Sufentanil consumption during the operation, pain score following the operation based on visual analog scale (VAS) and the morphine requirement for postoperative analgesia were assessed during the first 24 hours.
Results: Fifty patients were divided in two groups. During the operation, the opioid requirement was higher in the IV group, whereas the morphine requirement during the first 24 hours after the operation was the same in both groups. The duration of effective postoperative analgesia was longer in patients in the IT group. VAS pain scores were significantly lower during the first 2 hours postoperatively in the IT group. The incidence of side effects such as nausea, vomiting, headache and respiratory depression was infrequent in both groups.
Conclusions: Preoperative IT sufentanil can be used as a booster to achieve rapid and effective analgesia not only during the operation but also during the immediate postoperative period.
Intrathecal (IT) opioids have long been used as an adjunct to postoperative analgesia in many types of procedures, such as gynecology and obstetrics, urology, cardiovascular surgery orthopedic, thoracotomy and surgeries on the gastrointestinal tract with the aim of overcoming the stress response associated with such surgeries. This adjunct analgesic is also expected to lower the postoperative pain intensity and opioid requirements, while increasing the recovery pace.
Morphine, the commonly used analgesic for such purposes, is less hydrophobic than other opiates and therefore provides analgesia for a longer period of time; the high prevalence of postoperative adverse effects such as respiratory depression, particularly in its delayed forms, however, has raised certain concerns.
Certain studies have reported the benefits of sufentanil over morphine, indicating that IT sufentanil can provide good hemodynamics during major surgeries. While the high affinity of sufentanil to spinal and supraspinal receptors improves postoperative analgesia (1), its use is also associated with lower cardiopulmonary complications, mortality and cost, particularly in patients undergoing esophagectomy (2) Moreover, delayed analgesia and respiratory depression is rarely reported following such analgesia.
Despite all the above-mentioned benefits, not many studies have evaluated the value of intrathecal sufentanil for postesophagectomy analgesia. Therefore, it is not commonly used in the general practice. The aim of this study was to compare the analgesic properties of IT and intravenous (IV) sufentanil during transhiatal esophagectomy and in the first 24 hours after the procedure.
Abstract and Introduction
Abstract
Objectives: The present study compares the analgesic properties of intrathecal (IT group) and intravenous (IV group) sufentanil in postoperative pain relief.
Methods: This randomized, single blinded study was performed on patients awaiting transhiatal esophagectomy. The patients were randomly allocated to receive sufentanil intrathecally or intravenously. Sufentanil consumption during the operation, pain score following the operation based on visual analog scale (VAS) and the morphine requirement for postoperative analgesia were assessed during the first 24 hours.
Results: Fifty patients were divided in two groups. During the operation, the opioid requirement was higher in the IV group, whereas the morphine requirement during the first 24 hours after the operation was the same in both groups. The duration of effective postoperative analgesia was longer in patients in the IT group. VAS pain scores were significantly lower during the first 2 hours postoperatively in the IT group. The incidence of side effects such as nausea, vomiting, headache and respiratory depression was infrequent in both groups.
Conclusions: Preoperative IT sufentanil can be used as a booster to achieve rapid and effective analgesia not only during the operation but also during the immediate postoperative period.
Introduction
Intrathecal (IT) opioids have long been used as an adjunct to postoperative analgesia in many types of procedures, such as gynecology and obstetrics, urology, cardiovascular surgery orthopedic, thoracotomy and surgeries on the gastrointestinal tract with the aim of overcoming the stress response associated with such surgeries. This adjunct analgesic is also expected to lower the postoperative pain intensity and opioid requirements, while increasing the recovery pace.
Morphine, the commonly used analgesic for such purposes, is less hydrophobic than other opiates and therefore provides analgesia for a longer period of time; the high prevalence of postoperative adverse effects such as respiratory depression, particularly in its delayed forms, however, has raised certain concerns.
Certain studies have reported the benefits of sufentanil over morphine, indicating that IT sufentanil can provide good hemodynamics during major surgeries. While the high affinity of sufentanil to spinal and supraspinal receptors improves postoperative analgesia (1), its use is also associated with lower cardiopulmonary complications, mortality and cost, particularly in patients undergoing esophagectomy (2) Moreover, delayed analgesia and respiratory depression is rarely reported following such analgesia.
Despite all the above-mentioned benefits, not many studies have evaluated the value of intrathecal sufentanil for postesophagectomy analgesia. Therefore, it is not commonly used in the general practice. The aim of this study was to compare the analgesic properties of IT and intravenous (IV) sufentanil during transhiatal esophagectomy and in the first 24 hours after the procedure.
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