Subarachnoid sufentanil for early postoperative pain management in orthopedic patients - A placebo-controlled, double-blind study using spinal microcatheters
Tg. Standl et al., Subarachnoid sufentanil for early postoperative pain management in orthopedic patients - A placebo-controlled, double-blind study using spinal microcatheters, ANESTHESIOL, 94(2), 2001, pp. 230-238
Citations number
40
Categorie Soggetti
Aneshtesia & Intensive Care","Medical Research Diagnosis & Treatment
Background: Continuous spinal anesthesia is frequently used for intraoperat
ive anesthesia but rarely for postoperative pain management. Because even s
mall doses of local anesthetics can be associated with motor deficits, suba
rachnoid opioid injection may be an alternative.
Methods: Eighty patients randomly received a subarachnoid injection of 10 m
ug sufentanil, 5 mg bupivacaine, 2.5 mug sufentanil plus 2.5 mg bupivacaine
, or saline through 28-gauge spinal microcatheters for early postoperative
pain relief after major lon er-limb surgery (n = 20 in each group). Hemodyn
amic and respiratory parameters, pain scores, and motor function were monit
ored, and sufentanil concentrations in plasma and cerebrospinal fluid were
measured. Ten additional patients received up to three repetitive injection
s of 10 mug sufentanil over 24 h,
Results: All drugs provided excellent pain relief within 15 min after injec
tion, lasting 128 +/- 61 min with sufentanil 146 +/- 74 min with bupivacain
e, and 167 +/- 78 min with the mixture. Patients receiving bupivacaine show
ed the highest cephalad extension of sensory block (median, T6) and the mos
t intense motor block, whereas patients given only sufentanil had no motor
deficit. The duration of analgesia was shorter after subsequent sufentanil
injection (100-115 min) than after the first injection (198 +/- 70 min). Si
x of 50 patients with sufentanil experienced a short episode of respiratory
depression within 30 min after the first injection. Cerebrospinal fluid co
ncentrations of sufentanil peaked at 5 min after injection (183 +/- 167 ng/
ml) but were at the level of detection in the plasma.
Conclusions: Sufentanil injected through microspinal catheters provided pro
found pain relief without impairing motor function when compared with bupiv
acaine. However, close monitoring remains mandatory in this setting.