Safety and efficacy of patient controlled analgesia effect-site target controlled infusion of sufentanll in elderly patients after transurethral resection of the prostate

Abstract

Objective To evaluate the safety and efficacy of patient controlled analgesia effect-site target controlled infusion (PCA-TCI) of sufentanil in elderly patients after transurethral resection of benign prostatic hyperplasia (TURP). Methods Sixty elderly patients (ASA Ⅰ - Ⅱ ) scheduled for TURP were randomized into four groups (n=15 each). PCA-TCI was used in the first three groups with the same analgesic dosage (1 mg/L sufentanil) but different initial target plasma concentrations (Cp) (0.06 μg/L in group Ⅰ ,0.08 μg/L in group Ⅱ and 0.10 μg/L in group Ⅲ ) and minimum effective Cp (0.04 μg/L in group Ⅰ , 0.05μg/L in groups Ⅱ and Ⅲ ). The group Ⅳ was set as control group, using patient controlled epidural analgesia (PECA) with 0.06 mg/L morphine + 0.2％ ropivacaine+0.9％ normal saline under losding+continous+PCA (LCP) mode. After the operation, the analgesia device was switched on when the level of sensory blockade receded to T10. Before and at different time points after the start of analgesia, visual analogue score (VAS),Ramsay sedation score, modified Bromage score, plasma target concentration (Cp) of sufentanil, systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), blood oxygen saturation (SpO2),respiratory rate (RR) and patient satisfaction with analgesia were assessed. Moreover, number of patient-pressed bolus (D1) and of bolus delivered (D2) , the time to pass gas and adverse reactions were recorded.Results All the patients in the four groups were satisfied with the PCA device. At any given time points,there were no significant differences in Ramsay score among the 4 groups (P＞0.05), VAS and D1/D2 among groups Ⅱ, Ⅲ and Ⅳ (P＞0.05), whereas the VAS score in group Ⅰ was higher at 1, 2 and 4 hours (P＜0.05)compared to groups Ⅱ and Ⅲ. All the patients passed gas within 24 h, but the time to gas-passing was longer in group Ⅳ (19.1±2.5)h compared with group Ⅰ (16.5±3.9)h, group Ⅱ (16.2±3.8)h and groupⅢ (16.8±4.1 )h (P＜0.05). The total sufentanil use was similar in groups Ⅰ and Ⅱ[(36.7±5.1)μg vs (37.8±4.7)μg,P＞0.05], and was the highest in group Ⅲ (42.3±5.6) μg (P＜0.05). There was no significant difference in adverse reactions among the four groups. Conclusions PCA- TCI of sufentanil in elderly patients for postoperative analgesia after TURP is effective and safe. Configurations of sufentanil analgesia with initial target plasma concentration being 0.08 μg/L and minimum effective concentration being 0.05 μg/L may result in lowest VAS and reduced dosage, which is favorable for stable blood circulation among the patients. Key words: Sufentanil; Analgesia; Transurethral resection of prostate; Target-controlled infusion; Patient-controlled