Articles: opioid-analgesics.
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Efficacy and side effects of a continuous infusion of sufentanil following epidural administration of a single dose of 30 micrograms of the opioid were studied in 28 patients undergoing laparotomy. Patients were divided into two groups treated with either 10 micrograms/h (n = 13) or 15 micrograms/h (n = 15) and compared with regard to sufentanil plasma levels, side effects and changes in blood gases. ⋯ After the injection of a bolus of 30 micrograms sufentanil, a dose chosen according to current recommendations, a quick onset of analgesia was noted, but also sedation and respiratory depression with apneic intervals lasting up to 30 s, demonstrating both the efficacy and the possibility of unwanted and even harmful side effects associated with this kind of administration. During long-term infusion, after about 20 h PaCO2 and respiratory rate were significantly different between the two groups, which could be explained by differences in sufentanil plasma levels and a somewhat higher level of postoperative pain in the group receiving 10 micrograms/h.
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154 cancer pain patients were treated from 1988 to 1990 according to the three-step analgesic ladder (TSAL) recommended by the WHO. The patients were assigned into 4 groups: WHO-I: patients were treated only with non-opioids, WHO-II: patients received a combination of non-opioid plus a weak opioid, WHO-III: patients were treated with strong opioids or a combination of a strong opioid plus a non-opioid; and the 4th group consisted of patients receiving a strong opioid epidurally. ⋯ Also the mean duration of the patients' sleep was increased by more than one hour. An improvement of mood was observed, and the stabilisation of mood lasted longer.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of sufentanil-nitrous oxide anaesthesia with fentanyl-nitrous oxide anaesthesia in geriatric patients undergoing major abdominal surgery.
We have measured haemodynamic changes and plasma concentrations of catecholamines during sufentanil-nitrous oxide and fentanyl-nitrous oxide anaesthesia in a controlled, randomized, double-blind study of 20 geriatric patients (age 65-86 yr) undergoing major abdominal surgery. Fentanyl 7 micrograms kg-1 followed by infusion of 3 micrograms kg-1 h-1 was compared with sufentanil 1 micrograms kg-1 followed by 0.4 micrograms kg-1 h-1. The opioid was supplemented with 60-67% nitrous oxide in oxygen. ⋯ Haemodynamic state was stable during induction and tracheal intubation in both groups, while during stressful operative periods there were increases in mean arterial pressure (17% in the fentanyl group; 11% in the sufentanil group), heart rate (fentanyl 20%, sufentanil 14%) and plasma concentrations of catecholamines (adrenaline: fentanyl 316%, sufentanil 86%; noradrenaline: fentanyl 78%, sufentanil 186%) in both groups. Sufentanil was similar to fentanyl in attenuating the haemodynamic and hormonal responses to surgical stimulation. In two patients in the fentanyl group and three in the sufentanil group, myocardial lactate production was observed temporarily, indicating myocardial ischaemia caused by surgical stress.