Sufentanil during anesthetic induction of remifentanil-based total intravenous anesthesia: a randomized controlled trial

Menezes, Daniel C.; Vidal, Edison I.O.; Costa, Cesar M.; Mizubuti, Glenio B.; Ho, Anthony M.H.; Barros, Guilherme A.M.; Fukushima, Fernanda B.

doi:10.1016/j.bjane.2019.04.001

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Revista Brasileira de Anestesiologia

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Scientific Articles • Rev. Bras. Anestesiol. 69 (4) • Jul-Aug 2019 • https://doi.org/10.1016/j.bjane.2019.04.001 copy

Sufentanil during anesthetic induction of remifentanil-based total intravenous anesthesia: a randomized controlled trial

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background

Postoperative pain represents an important concern when remifentanil is used for total intravenous anesthesia because of its ultrashort half-life. Longer acting opioids, such as sufentanil, have been used during induction of remifentanil-based total intravenous anesthesia as a means to overcome this shortcoming. However, the effectiveness and safety of such strategy still lacks evidence from randomized clinical trials. Hence, we aimed to assess the postoperative analgesic efficacy and safety of a single dose of sufentanil administered during the induction of remifentanil-based total intravenous anesthesia.

Methods

Forty patients, scheduled for elective open abdominal surgery, were randomized to receive remifentanil-based total intravenous anesthesia with or without a single dose of sufentanil upon induction. We assessed the postoperative morphine consumption administered through a patient-controlled analgesia pump. Self-reported pain scores and the occurrence of nausea, vomiting, pruritus, agitation, somnolence and respiratory depression were also assessed up to 2 days after surgery.

Results

The mean difference between the sufentanil and control groups regarding morphine consumption in the post-anesthetic care unit and at 12, 24 and 48 h after surgery were -7.2 mg (95%CI: -12.5 to -2.1, p < 0.001), -3.9 mg (95%CI: -11.9 to 4.7, p = 0.26), -0.6 mg (95%CI: (-12.7 to 12.7, p = 0.80), and -1.8 mg (95%CI: (-11.6 to 15.6, p = 0.94), respectively. Neither self-reported pain nor the incidence of adverse events were significantly different between groups at any time point.

Conclusion

Our findings suggest that the administration of sufentanil during induction of remifentanil-based total intravenous anesthesia is associated with decreased early postoperative opioid consumption.

Keywords
Acute pain; Pain; Opioid; Total intravenous anesthesia

Baseline characteristics	Sufentanil Group	Control Group	Standardized difference
Age (years)^a a Data presented as mean (standard deviation).	52.2 (10.1)	52.0 (16.4)	0.04
Female^b b Data presented as absolute number (%). ASA, American Society of Anesthesiology physical status classification.	16 (76.2%)	16 (84.2%)	0.20
Body mass index^a a Data presented as mean (standard deviation).	28.1 (5.3)	26.8 (2.5)	0.05
ASA^b b Data presented as absolute number (%). ASA, American Society of Anesthesiology physical status classification.			0.72
ASA 1	10 (47.6%)	15 (78.9%)
ASA 2	10 (47.6%)	4 (21.1%)
ASA 3	1 (4.8%)	0
Surgical procedure^b b Data presented as absolute number (%). ASA, American Society of Anesthesiology physical status classification.			0.67
Cholecystectomy	4 (19.0%)	7 (36.8%)
Hysterectomy	13 (61.9%)	11 (57.9%)
Gastrectomy	1 (4.8%)	1 (5.3%)
Splenectomy	1 (4.8%)	0 (0%)
Exploratory laparotomy	2 (9.5%)	0 (0%)
Duration of surgery^a a Data presented as mean (standard deviation). (min)	157.4 (53.1)	140.5 (41.1)	0.07

Morphine consumption	Sufentanil Group Mean (SD)	Control Group Mean (SD)	Mean difference (95% CI)^a a p-Values and 95% CI were calculated using nonparametric bootstrap based on the Bias-Corrected and accelerated method.	p ^a a p-Values and 95% CI were calculated using nonparametric bootstrap based on the Bias-Corrected and accelerated method.
In PACU
0-15 min	2.1 (2.0)	5.3 (3.1)	-3.2 (-4.9 to -1.8)	<0.001
16-30 min	1.9 (1.7)	2.8 (2.7)	-0.9 (-2.4 to 0.3)	0.20
31-60 min	2.3 (2.5)	3.8 (3.3)	-1.5 (-3.3 to 0.23)	0.12
61 min to discharge from PACU	2.5 (3.1)	4.1 (4.0)	-1.6 (-3.8 to 0.5)	0.17
Total in PACU	8.8 (7.0)	16.0 (10.1)	-7.2 (-12.5 to -2.1)	<0.001
12 h after surgery	20.6 (13.4)	24.5 (12.7)	-3.9 (-11.9 to 4.7)	0.26
24 h after surgery	32.3 (21.9)	32.9 (19.3)	-0.6 (-12.7 to 12.7)	0.80
48 h after surgery	41.1 (20.9)	39.3 (20.9)	1.8 (-11.6 to 15.6)	0.94

Postoperative pain	Sufentanil Group Mean (SD)	Control Group Mean (SD)	Mean difference (95% CI)^a a p-Values and 95% CI were calculated using nonparametric bootstrap based on the Bias-Corrected and accelerated method.	p ^a a p-Values and 95% CI were calculated using nonparametric bootstrap based on the Bias-Corrected and accelerated method.
At PACU
15 min	5.6 (3.4)	6.6 (4.2)	-1.0 (-3.2 to 1.4)	0.10
30 min	5.2 (3.3)	5.8 (4.1)	-0.6 (-2.9 to 1.7)	0.17
60 min	4.2 (3.5)	5.3 (3.9)	-1.1 (-3.3 to 1.2)	0.07
At discharge from PACU	1.8 (2.6)	2.4 (3.0)	-0.6 (-2.4 to 1.1)	0.06
Postoperative day 1	1.6 (2.0)	1.2 (2.2)	0.6 (-1.0 to 1.6)	0.35
Postoperative day 2	1.2 (1.9)	1.2 (1.8)	0.0 (-1.0 to 1.2)	0.10

Adverse events	Sufentanil Group	Control Group	Risk ratio (95% CI)	p
In PACU
Nausea	3 (14.3%)	6 (31.6%)	0.45 (0.13-1.56)	0.21
Vomiting	0 (0%)	1 (5.2%)	0.30 (0.01-7.02)	0.46
Pruritus	0 (0%)	1 (5.2%)	0.30 (0.01-7.02)	0.46
Sedation	10 (47.6%)	4 (21.1%)	2.26 (0.85-6.02)	0.10
Agitation	7 (33.3%)	8 (42.1%)	0.79 (0.35-1.77)	0.48
Respiratory depression	1 (4.8%)	1 (5.2%)	0.91 (0.06-13.50)	1
Between discharge from PACU and assessment on postoperative day 2
Nausea	0 (0%)	3 (15.9%)	0.13 (0-0.36)	0.17
Vomiting	2 (9.5%)	1 (5.2%)	1.81 (0.18-18.39)	0.94
Pruritus	1 (4.8%)	2 (10.5%)	0.45 (0.05-4.60)	0.60
Sedation	0 (0%)	0 (0%)	0.91 (0.02-43.71)	1.00
Agitation	0 (0%)	0 (0%)	0.91 (0.02-43.71)	1.00
Respiratory depression	0 (0%)	0 (0%)	0.91 (0.02-43.71)	1.00

Sociedade Brasileira de Anestesiologia R. Professor Alfredo Gomes, 36, 22251-080 Botafogo RJ Brasil, Tel: +55 21 2537-8100, Fax: +55 21 2537-8188 - Campinas - SP - Brazil
E-mail: bjan@sbahq.org

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[1] * Corresponding author. E-mail:f.fukushima@unesp.br (F.B. Fukushima).