Epidural Sufentanil Infusion for Postoperative Analgesia

Abstract

Objective:

To determine analgesic qualities of epidural sufentanil, associated plasma concentrations, and incidence of adverse effects.

Design:

Case series.

Setting:

Postanesthesia care unit of a tertiary care facility.

Patients:

Thirteen patients undergoing elective intraabdominal surgery.

Interventions:

Postsurgical analgesia was maintained with epidural sufentanil infusion (0.3–0.6 μg/kg/h). Epidural boluses of sufentanil 0.3 μg/kg had been administered prior to sufentanil infusion to achieve adequate analgesia.

Main Outcome Measures:

Quality of analgesia was measured with a visual analog scale (VAS). Adverse effects measured included nausea, vomiting, and pruritus. Respiratory function was monitored with end-tidal CO₂, pulse oximetry, and respiratory rate. To determine systemic absorption, plasma concentrations of sufentanil were measured.

Results:

Analgesia occurred within five minutes after bolus epidural sufentanil injection. Mean ± SEM VAS scores decreased from 6.2 ± 0.7 at time 0 to 2.4 ± 0.6 after five minutes and were less than three over the next eight hours. One of 13 patients became nauseated and one experienced hypotension and respiratory depression during the study period. Mean plasma sufentanil concentrations were <0.1 ng/mL for the first seven hours and at the lower limits of assay detection (0.1 ng/mL) during hour 8. After 24 and 48 hours of epidural sufentanil infusion, the mean plasma sufentanil concentration was 0.4 ± 0.1 (n=8) and 0.4 ± 0.1 ng/mL (n=4), respectively.

Conclusions:

These data suggest that epidural sufentanil can provide rapid postoperative analgesia. Plasma sufentanil concentration tends to increase with the duration of infusion, which could increase the risk of respiratory depression.