PATIENT-CONTROLLED ANALGESIA WITH SUFENTANIL - A COMPARISON OF 2 DIFFERENT METHODS OF ADMINISTRATION

Study Objective: To examine the safety and analgesic efficacy of sufen tanil administered via either epidural or intravenous (IV) patient-con trolled analgesia (PCA) in patients recovering from gynecologic surger y. Design: Randomized, double-blind comparison. Setting: Patient care unit at a university medical center. Patients: 29 healthy women presen ting for major intraabdominal gynecologic surgery with epidural anesth esia who requested postoperative PCA. Interventions: Following complet ion of surgery performed using epidural anesthesia with 2% lidocaine a nd IV sedation, patients were assigned to one of three treatment group s: Group 1-epidural PCA (EPCA) with sufentanil: 0.3 mu g/kg bolus foll owed by 8 mu g/hr infusion plus epidural PCA boluses of 4 mu g every 6 min as needed; Group 2-IV PCA with sufentanil: 0.3 mu g/kg bolus foll owed by 8 mu g/hr infusion plus IV PCA boluses of 4 mu g every 6 min a s needed; or Group 3-IV PCA with morphine: 0.1 mg/kg bolus followed by 0.5 mg/hr infusion plus IV PCA boluses of 1 mg every 6 min as needed. Measurements and Main Results: Patients were observed at regular inte rvals during a 24-hour evaluation period. Visual analog scale (VAS) sc ores were used to assess analgesia and satisfaction with therapy. Pulm onary function runs assessed by monitoring respiratory rate, oxygen (O -2) saturation, and forced expiratory flow. Total opioid dose delivere d and the presence/severity of side effects was also collected. Sufent anil plasma levels were measured in a subset of eight patients. Patien ts receiving either EPCA or IV PCA sufentanil experienced equivalent a nalgesia that was more rapid in onset than IV PCA morphine. Total dose administered and plasma concentration of drug were similar in both su fentanil groups; however, a greater number of patients in the IV deliv ery group experienced clinically significant O-2 desaturation. Conclus ions. The main advantage of EPCA sufentanil in this postsurgical setti ng was its ability to provide a more rapid onset of analgesia than tra ditional IV PCA with morphine while offering greater safety than IV su fentanil.