Addition Of Sufentanil Research Articles

Additive Effect of Sulfantil to Lidocain and Bupivacain for Supraclavicular Brachial Plexus Block

Purpose: We evaluated the effect of adding Sufentanil to the mixture of Lidocaine and Bupivacaine used for supraclavicular brachial plexus block in reducing postoperative pain.
 Method: This double-blind clinical intervention trial was conducted in 2007. Patients scheduled to undergo upper limb orthopedic surgeries under supraclavicular brachial plexus block were recruited. Participants of one arm were given the mixture of Sufentanil, lidocaine, and bupivacaine (Group S) while those of the other arm were given the mixture of later two drugs (Group C). Postoperative pain assessment was done every hour postoperatively till the first administration of systemic analgesic. We used a subjective pain score and duration of lack of muscle movement as a parameter to judge outcomes. The mean and standard deviation were compared of both arms.
 Result: We included 50 patients in both arms. The mean duration of the motor blockade in group S and C were 342.8 (± 145.4) and 171.1 (±50.2) minutes respectively. The additive effect of Sufentanil in motor blockage was 171.7 (95% CI 128.5–214.9) (p = 0.1×10-6). The mean duration of analgesia in group S and C were 892 (±34.7) and 350 (±72.1) minutes respectively. The additive effect of Sufentanil in analgesia was 542 (95% CI 524–559) (p = 0.1×10-6). In group S, one patient developed cardiac pain following pneumothorax and two had temporary Horner syndrome.
 Conclusion: Analgesia in the postoperative period can be enhanced with the addition of Sufentanil (an opioid) to local anesthetics in supraclavicular brachial plexus block.

Sufentanil and Bupivacaine Combination versus Bupivacaine Alone for Spinal Anesthesia during Cesarean Delivery: A Meta-Analysis of Randomized Trials.

ObjectiveThe addition of lipophilic opioids to local anesthetics for spinal anesthesia has become a widely used strategy for cesarean anesthesia. A meta-analysis to quantify the benefits and risks of combining sufentanil with bupivacaine for patients undergoing cesarean delivery was conducted.MethodsA comprehensive literature search without language or date limitation was performed to identify clinical trials that compared the addition of sufentanil to bupivacaine with bupivacaine alone for spinal anesthesia in healthy parturients choosing cesarean delivery. The Q and I2 tests were used to assess heterogeneity of the data. Data from each trial were combined using relative ratios (RRs) for dichotomous data or weighted mean differences (WMDs) for continuous data and corresponding 95% confidence intervals (95% CIs) for each trial. Sensitivity analysis was conducted by removing one study a time to assess the quality and consistency of the results. Begg’s funnel plots and Egger’s linear regression test were used to detect any publication bias.ResultsThis study included 9 trials containing 578 patients in the final meta-analysis. Sufentanil addition provided a better analgesia quality with less breakthrough pain during surgery than bupivacaine alone (RR = 0.10, 95% CI 0.06 to 0.18, P < 0.001). Sensory block onset time was shorter and first analgesic request time was longer in sufentanil added group compared with the bupivacaine-alone group (WMD = −1.0 min, 95% CI −1.5 to −0.58, P < 0.001 and WMD = 133 min, 95% CI 75 to 213, P < 192, respectively). There was no significant difference in the risk of hypotension and vomiting between these two groups. But pruritus was more frequentely reported in the group with sufentanil added (RR = 7.63, 95% CI 3.85 to 15.12, P < 0.001).ConclusionBupivacaine and sufentanil combination is superior to that of bupivacaine alone for spinal anesthesia for cesarean delivery in analgesia quality. Women receiving the combined two drugs had less breakthrough pain, shorter sensory block onset time, and longer first analgesic request time. However, the addition of sufentanil to bupivacaine increased the incidence of pruritus.

Sparing effects of sufentanil on epidural ropivacaine in elderly patients undergoing transurethral resection of prostate surgery.

PurposeThis study examined the sparing effect of sufentanil on the median effective concentration (EC50) of epidural ropivacaine in elderly patients undergoing elective transurethral resection of prostate (TURP).Materials and MethodsThis was a prospective randomized double-blind dose-response study. Fifty eight elderly patients with American Society of Anesthesiologists physical status I-II who were scheduled for TURP surgery under epidural anesthesia were randomly allocated to a group receiving 15 mL of ropivacaine (group R) or a group receiving ropivacaine plus 5 µg of sufentanil (group RS). The concentration of ropivacaine was determined by a Dixon's up-and-down sequential allocation. The first participant received 0.3% of ropivacaine in both groups and subsequent concentrations were determined by the response of the previous patient in the same group. The EC50 of epidural ropivacaine was analyzed using the Dixon and Massey method.ResultsThe EC50 of ropivacaine during TURP surgery was 0.186% (95% confidence interval, 0.173-0.200%) in group R, and 0.136% (95% confidence interval, 0.127-0.144%) in group RS (p<0.01). No differences in Bromage scale of motor block examination and the onset time of sensory block were observed.ConclusionAdministration of 5 µg of epidural sufentanil caused a 37% reduction in the EC50 of epidural ropivacaine in elderly patients who underwent TURP surgery. Thus, sufentanil addition during surgery of TURP can decrease the dose of ropivacaine anesthesia required.

Comparison of Intrathecal Levobupivacaine Combined with Sufentanil, Fentanyl, or Placebo for Elective Caesarean Section: A Prospective, Randomized, Double-Blind, Controlled Study

BackgroundThe addition of opioids to local anesthetics contributes to the quality of spinal anesthesia and postoperative analgesia. ObjectiveIn our prospective, randomized, double-blind, controlled study, our aim was to compare the effect of low-dose sufentanil plus levobupivacaine or a fentanyl plus levobupivacaine mixture on anesthesia quality, block characteristics, newborn and mother well-being, surgeon satisfaction, and duration of postoperative analgesia. MethodsNinety-three patients were randomized into 3 groups (n = 31). Patients in Group C received 0.5% levobupivacaine (2.2 ± 0.2 mL), Group S received 2.5 µg sufentanil plus 0.5% levobupivacaine (2.2 ± 0.2 mL), and Group F received 10 µg fentanyl plus 0.5% levobupivacaine (2.2 ± 0.2 mL) intrathecally completed to a volume of 3 mL with the addition of saline in all groups. Patients’ demographics, sensory and motor block characteristics, hemodynamics, Apgar scores, umbilical blood gas values, maternal side effects, surgeon satisfaction score, time to first analgesia requirement, and additional analgesic use within 24 hours were recorded. ResultsIn Group S and Group F, target levels of sensory and motor block were achieved more rapidly (P < 0.001). The hemodynamic values were lower (P < 0.05), and the duration of sensory blockade and the time of first analgesic requirement were longer (P < 0.001) in Group S. Additional analgesic requirement during first 24-hour period was lowest in Group S, and highest in Group C (P < 0.001). Apgar scores and umbilical blood gas samples were similar between groups. Postoperative pruritus was more frequent in Group S (P < 0.001) and surgeon satisfaction score was significantly lower in Group C (P = 0.003). ConclusionsWe suggest that the addition of sufentanil and fentanyl to intrathecal levobupivacaine during caesarean section surgery is more effective than the administration of levobupivacaine alone. The addition of sufentanil to levobupivacaine allowed rapid onset time for sensory and motor block levels. It also extended the duration of postoperative analgesia and led to a decrease in total analgesic requirement. ClinicalTrials.gov identifier: NCT01858090.

Effects of caudal sufentanil supplemented with levobupivacaine on blocking spermatic cord traction response in pediatric orchidopexy

Caudal block is one of the most commonly used anesthetic techniques in subumbilical and genitourinary procedures. However, traditional administration of caudal levobupivacaine was inadequate on blocking peritoneal response during spermatic cord traction. The aim of this study was to evaluate whether the addition of caudal sufentanil to levobupivacaine provided better analgesia for children undergoing orchidopexy. Sixty-two patients, scheduled for right orchidopexy, received caudal block after induction. Group LS (n = 31) received levobupivacaine 0.25% 1 ml/kg plus sufentanil 0.5 μg/kg, and group L (n = 31) received levobupivacaine 0.25% 1 ml/kg only. HR or MAP fluctuation >20% or entropy increase >15% during spermatic cord traction was defined as inadequate anesthesia and was treated with increasing sevoflurane concentration. The number of children who needed sevoflurane rescue was counted, and postoperative side effects and quality of sleep were also recorded. There were no statistically significant differences between the two groups in age, weight, and duration of surgery. Two (6.45%) children in group LS required inspired sevoflurane rescue to block hemodynamic fluctuation during spermatic cord traction, as compared with 12 (38.71%) patients in group L (P < 0.001). At the time of exerting spermatic cord traction, the median HR was, respectively, 134 and 145 (P < 0.001); the corresponding response entropy (RE) and state entropy (SE) was 65 and 54, respectively, in group LS versus 76 and 65 in group L (P < 0.001). In pediatric orchidopexy, the addition of sufentanil to levobupivacaine for caudal blockade offers clinical benefit over levobupivacaine alone in blocking the spermatic cord traction response.

Spinal Anesthesia for Cesarean Section. Use of Hyperbaric Bupivacaine (10 mg) Combined with Different Adjuvants

Combination of local anesthetics (LA) with adjuvants for spinal anesthesia improves block quality and prolongs the duration of analgesia. It was evaluated the maternal effects and neonatal repercussions of sufentanil, morphine, and clonidine combined with hyperbaric bupivacaine for elective cesarean section. Prospective, randomized, blinded study of 96 patients allocated into four groups: Group I (no adjuvant), Group II (sufentanil 5.0 μg), Group III (morphine 100 μg), and Group IV (clonidine 75 μg). It was evaluated the onset and level of sensory block, perioperative analgesia, degree and recovery time of motor block, duration of analgesia, sedation, and maternal-fetal repercussions. The onset of blockade was significantly faster in groups with adjuvants compared with Group I. Patients in Groups I and III reported pain during the perioperative period. Duration of analgesia was significantly higher in Group II and time to motor block recovery was significantly higher in Group IV. Pruritus occurred in Groups II and III. Sedation was significant in Group IV and there was prolonged arterial hypotension in Group IV. Addition of sufentanil and clonidine to hyperbaric bupivacaine provided adequate anesthesia for cesarean section and good postoperative analgesia. Clonidine caused more perioperative sedation and longer time to motor block recovery. Pruritus was evident when opioids were used.

Incidence of Shivering after Cesarean Section under Spinal Anesthesia with or without Intrathecal Sufentanil: A Randomized Study

Shivering is a cause of discomfort and dissatisfaction in patients undergoing cesarean section. The objective of this study paper was to assess the impact of intrathecal administration of sufentanil on the incidence of shivering after cesarean section.In a prospective blinded, randomized clinical trial, pregnant women undergoing cesarean section under spinal anesthesia were enrolled. Pregnant women in labor, febrile, obese, with pregnancy-induced hypertension, anesthetic block failure or surgical complications were excluded. Patients were randomly assigned to two groups. In Group I, 10mg of 0.5% hyperbaric bupivacaine combined with 80 mcg of morphine and 2.5 mcg of sufentanil were administered. In Group II, 10mg of 0.5% hyperbaric bupivacaine combined with 80 mcg of morphine were administered. In the post-anesthesia care unit, patients were evaluated for signs of shivering by an investigator blinded to the patient's group allocation.The sample consisted of 80 patients. In both groups there was a decrease in axillary temperature of patients after cesarean section (p<0.001). This decrease was not different between groups (p<0.21). In Group I, the incidence of tremor was 32.5% (13/40) and in Group II it was 62.5% (25/40) (p<0.007); RR 0.53 (CI 95% 0.32-0.87).It has been suggested that the addition of sufentanil to hyperbaric bupivacaine and morphine during spinal anesthesia for cesarean section provides a decrease in the incidence of shivering in the immediate postoperative period.

Comparison of clinical effects according to the dosage of sufentanil added to 0.5% hyperbaric bupivacaine for spinal anesthesia in patients undergoing cesarean section

BackgroundSubarachnoid block is a widely used technique for cesarean section. To improve the quality of analgesia and prolong the duration of analgesia, addition of intrathecal opioids to local anesthetics has been encouraged. We compared the effects of sufentanil 2.5 µg and 5 µg, which were added to intrathecal hyperbaric bupivacaine.MethodsWe enrolled 105 full term parturients were randomly divided into 3 groups: Group 1 (control), Group 2 (sufentanil 2.5 µg), and Group 3 (sufentanil 5 µg). In every group, 0.5% heavy bupivacaine was added according to the adjusted dose regimen. We determined the maximum level of sensory block and motor block, the quality of intraoperative analgesia, the duration of effective analgesia and side effects.ResultsThere were no significant differences among the 3 groups in the maximum level of the sensory block and motor block. Recovery rate of the sensory block, however, was significantly slower in Group 3 than Group 1. Quality of intraopertive analgesia, muscle relaxation, and duration of effective analgesia were enhanced by increasing the dosage of intrathecal sufentanil. Frequencies of hypotension, maximum sedation level, and pruritus were directly related to the dosage of intrathecal sufentanil, whereas nausea and vomiting occurred only in the groups using sufentanil.ConclusionsThe addition of sufentanil 2.5 µg for spinal anesthesia provides adequate intraoperative analgesia and good postoperative analgesia with minimal adverse effects on the mother.

Neuraxial opioids in geriatrics: A dose reduction study of local anesthetic with addition of sufentanil in lower limb surgery for elderly patients

Background and Objectives:Neuraxial anesthesia in the elderly is associated with exaggerated responses to conventional doses of local anesthetics, thereby increasing the incidence of hemodynamic complications. A double-blind prospective study was carried out in our institute with an aim to compare the hemodynamic stability and quality of the conventional dose of hyperbaric bupivacaine (LA) with low dose of LA and sufentanil in elderly patients scheduled for lower limb surgery, randomized to receive combined spinal epidural anesthesia.Methods:A total of 50 elderly patients of ASA grade I and II, divided randomly into groups I and II, of either sex undergoing lower limb surgery under combined spinal epidural anesthesia at our institute attached to a Government Medical College were enrolled for study. Group I received 2.5 ml of intrathecal hyperbaric bupivacaine (LA), while group II received 1.5 ml of intrathecal LA+0.1 ml sufentanil (5 μg). Both initial and postoperative subarachnoid block characteristics, hemodynamic and respiratory parameters, duration of analgesia, and side effects were observed and recorded. Statistical analysis was carried out using Chi-square and paired t test.Results:Demographic profile was comparable in both groups. Group I had a greater incidence of hypotension and, consequently, higher use of vasopressors (P<0.05). Onset of sensory analgesia, time to achieve peak sensory level, and recovery from motor blockade were significantly earlier in group II (P<0.05). Postoperative consumption of LA through epidural route was significantly higher in group I (P<0.05). The side effect profile was similar, except for a significantly higher incidence of shivering in group I (P<0.05).Conclusions:The study established that the dose of a local anesthetic can be safely and significantly lowered by 40%, with addition of low-dose sufentanil, thereby avoiding the hemodynamic fluctuation and providing a stable perioperative and postoperative period in the geriatric population. In addition, duration of sensory analgesia is prolonged and postoperative requirement for the epidural top-up also decreases.

Comparative study of intrathecal sufentanil bupivacaine versus intrathecal bupivacaine in patients undergoing elective cesarean section

Sufentanil added to intrathecal bupivacaine for cesarean section has shown to improve intraoperative and postoperative analgesia with no adverse effects on the mother and neonate. We compared the effects of intrathecal sufentanil 5 mcg and placebo when administered with hyperbaric bupivacaine 0.5% 11 mg for cesarean section. Sixty parturients of ASA grading I and II of age between 18 to 45 years scheduled for elective cesarean section under subarachnoid block were randomly allocated into one of the two groups to receive 5μg sufentanil + 0.2ml sterile, preservative- free normal saline (Group S) and 0.3ml sterile, preservative-free normal saline (Group C) along with 2.2ml 0.5% hyperbaric bupivacaine making total volume to 2.5 ml. The two groups were compared with respect to their sensory and motor block characteristics, duration of analgesia, intraoperative haemodynamic changes, adverse effects and effect on neonatal Apgar score. Postoperative pain was assessed using the visual analog scale (VAS). Duration of analgesia was defined as the time taken for a VAS score of 4 to be achieved. Mean duration of analgesia was significantly prolonged in sufentanil group (184.0 + 51.50 minutes) than the control group (107.0 ± 46.40 minutes). There is faster onset of sensory and motor block in the sufentanil group. The incidences of bradycardia and hypotensive episodes were similar in the two groups. There was no evidence of respiratory depression in any of the patients in any groups. Pruritus was observed in 6 (20.0%) patients in Group S which was statistically significant. There was no significant effect on Apgar score of the neonate. Thus the addition of Sufentanil (5 mcg) intrathecally provides improved postoperative analgesia and haemodynamic stability with minimal side effects.

Adding sufentanil to levobupivacaine or ropivacaine intrathecal anaesthesia affects the minimum local anaesthetic dose required

We carried out this prospective, randomized, double-blind study in order to evaluate whether the intrathecal addition of sufentanil 3.3 mcg affects both the minimum local anaesthetic dose (MLAD) of spinal levobupivacaine and ropivacaine for a caesarean section and enhances the spinal block characteristics. One hundred and eighty women were randomly allocated into four groups: levobupivacaine (Group L), levobupivacaine plus sufentanil (Group L+S), ropivacaine (Group R) and ropivacaine plus sufentanil (Group R+S). Each received 3 ml of the study solution intrathecally as part of a combined spinal/epidural technique. The initial dose was 12 mg for Groups L and L+S, and 15 mg for Groups R and R+S. The test solution was required to achieve a visual analogue pain score (VAPS) of 30 mm or less to be considered effective at skin incision, uterine incision, birth, peritoneal closure and at the conclusion of surgery. Effective or ineffective responses determined a 0.5 mg decrease or increase of the same drug, respectively, for the next patient in the same group, using an up-down sequential allocation. Using the Dixon and Massey formula, the MLAD was 10.65 mg [confidence interval (CI) 95%: 10.14-11.56] in Group L, 4.73 mg (CI 95%: 4.39-5.07) in Group L+S, 14.12 mg (CI 95%: 13.50-14.60) in Group R and 6.44 mg (CI 95%: 5.86-7.02) in Group R+S. The addition of sufentanil reduced the MLAD of both the local anaesthetics. It did not affect their potency ratio significantly and resulted in enhanced spinal anaesthesia.

Comparative Evaluation between intrathecal sufentanil with bupivacaine to fentanyl with bupivacaine and bupivacaine alone for intraoperative and postoperative analgesia in infraumblical surgeries

This study was conducted to compare sufentanil & fentanyl in combination with bupivacaine for infra-umbilical surgeries. Sixty ASA I and II patients for elective intra-umbilical surgeries under spinal anaesthesia were divided into three groups to receive 15 mg bupivacaine alone, 10 g sufentanil & 25 g fentanyl in combination with 15mg bupivacaine. Onset time of sensory blockade, Duration of side effects, surgical conditions, and quality of the anaesthesia was assessed. The duration of effective analgesia of bupivacaine alone was prolonged with the addition of sufentanil and fentanyl by 179% and 141% respectively. No patient is the sufentanil and fentanyl groups required additional intra-operative analgesics compared with 17.6% of patients in the bupivacaine alone group. There was an increase in incidence of desaturation in the sufentanil group (45%) and fentanyl group (5.6%) compared with the bupivacaine only group (0%). The incidence of pruritus was 35% with sufentanil, 27.8% with fentanyl against 0% with bupivacaine alone. The addition of 10 g of sufentanil and 25 g of fentanyl to improved intraoperative analgesia. However, the incidence of pruritus and episodes of desaturation were increased more with 10 g sufentanil than with 25 g fentanyl.

Caudal anesthesia for minor subumbilical pediatric surgery: a comparison of levobupivacaine alone and levobupivacaine plus sufentanil

Study Objectives To compare the postoperative analgesic efficacy and duration of analgesia after caudal levobupivacaine 0.20% with and without the addition of sufentanil 0.5 μg kg −1. Design Prospective, randomized study. Setting University teaching hospital. Patients 40 ASA physical status I pediatric patients, aged one to 7 years, who were scheduled for elective minor subumbilical surgery. Interventions Patients were divided into two groups to receive either a single caudal injection of one mL kg −1 levobupivacaine 0.20% (Group L) or levobupivacaine 0.20% plus sufentanil 0.5 μg kg −1 (Group LS). Measurements Analgesia (Children and Infants Postoperative Pain Scale score), motor block (Motor Blockade Scoring), and side effects were assessed at predetermined time points during the first 24 postoperative hours. Main Results The Children and Infants Postoperative Pain Scale scoring at the first hour was significantly lower in Group LS than in Group L. No significant differences were found between the two groups for pain scores at two, three, 4, 5, 6, 9, 12, and 24 hours. Degree of motor block was comparable between the two groups. Conclusion The effect of adding sufentanil to caudal levobupivacaine on postoperative pain scores is brief after elective minor subumbilical surgery in children.

494: Effect of Intrathecal Sufentanil Addition on the Minimum Local Anesthetic Dose (MLAD) of Intrathecal Levobupivacaine and Ropivacaine for Cesarean Section

494: Effect of Intrathecal Sufentanil Addition on the Minimum Local Anesthetic Dose (MLAD) of Intrathecal Levobupivacaine and Ropivacaine for Cesarean Section

494. Effect of Intrathecal Sufentanil Addition on the Minimum Local Anesthetic Dose (MLAD) of Intrathecal Levobupivacaine and Ropivacaine for Cesarean Section

494. Effect of Intrathecal Sufentanil Addition on the Minimum Local Anesthetic Dose (MLAD) of Intrathecal Levobupivacaine and Ropivacaine for Cesarean Section

Effect of Intrathecal Sufentanil Addition on the Minimum Local Anesthetic Dose (MLAD) of Intrathecal Levobupivacaine and Ropivacaine for Cesarean Section

Effect of Intrathecal Sufentanil Addition on the Minimum Local Anesthetic Dose (MLAD) of Intrathecal Levobupivacaine and Ropivacaine for Cesarean Section

Impact of the addition of sufentanil 5 μg or clonidine 75 μg on the minimum local analgesic concentration of ropivacaine for epidural analgesia in labour: a randomized comparison

Background Addition of lipophilic opioids or α 2-agonists to local anaesthetic solutions reduces local anaesthetic requirements and side effects. While the efficacy and side effects of these adjuvants are dose-related, information about their relative analgesic potencies is lacking, making it difficult to draw meaningful clinical conclusions. The aim of the present study was to assess the relative sparing of ropivacaine by clinically relevant doses of sufentanil and clonidine using the minimum local analgesic concentration (MLAC) model. Methods In this prospective, double-blind study, the sparing effect of sufentanil 5 μg and clonidine 75 μg on the MLAC of ropivacaine administered for labour epidural analgesia was compared in 78 women at <5 cm cervical dilatation. Women were randomly allocated to one of three groups: plain ropivacaine, ropivacaine with sufentanil 5 μg and ropivacaine with clonidine 75 μg. Results The MLAC of plain ropivacaine was 0.099% wt/vol (95%CI: 0.090 to 0.109) and was reduced to 0.036% wt/vol (95% CI: 0.024 to 0.049) when combined with sufentanil 5 μg and to 0.036% wt/vol (95% CI: 0.027 to 0.046) with clonidine 75 μg ( P < 0.001). The wt/wt local anesthetic sparing potency ratio of sufentanil to clonidine was 15.1 (95% CI: 10.3 to 23.4). Conclusions Sufentanil 5 μg and clonidine 75 μg produce similar reductions in the MLAC of ropivacaine. This finding will make feasible the assessment of the side effects of these adjuvants administered at equipotent doses in further studies.

Intra-articular Sufentanil in Multimodal Analgesic Management After Outpatient Arthroscopic Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized, Double-Blinded Study

This prospective, randomized, blinded study was designed to evaluate the effectiveness of intra-articular sufentanil, ropivacaine, and clonidine compared with that of ropivacaine and clonidine without sufentanil on postoperative pain after arthroscopic reconstruction of the anterior cruciate ligament of the knee. One hundred twenty patients were enrolled and randomly divided into 2 groups. At the end of the operation, the surgeon injected 20 mL of a solution containing 5 microg sufentanil, 100 mg ropivacaine, and 1 microg/kg clonidine in the knees of patients in group A whereas the surgeon injected the same solution without sufentanil in group B. During the postoperative period and for the first 24 hours, we recorded pain intensity using a visual analog scale. All patients were discharged after a few hours with well-controlled pain. Pain scores were low in both groups both before and after discharge. We did not show any difference in pain scores at any time point. During the first postoperative hour, patients in group B required more rescue analgesic drugs (P < .05). In our patients the addition of sufentanil in the intra-articular solution did not provide better control of pain. Level I, therapeutic randomized controlled trial.

Addition of sufentanil to bupivacaine in caudal block effect on stress responses in children

The aim of the present randomized study was to determine the effect of adding sufentanil to bupivacaine, compared with bupivacaine alone in caudal block, on the surgical stress response in children. The children were premedicated with midazolam 0.5 mg/kg. All children received induction with nitrous oxide and sevoflurane. Anesthesia was maintained with the same volatile agents in the both groups. The children were randomly allocated to two groups. Group I received bupivacaine alone (n = 17) and group II received bupivacaine + sufentanil (n = 16). Caudal block was performed with 0.25% bupivacaine 2 mg/kg (group I) or 0.25% bupivacaine 2 mg/kg with sufentanil 0.5 microg/kg (group II) after induction of anesthesia. Blood samples were obtained after induction of anesthesia (T(0)) to measure baseline concentrations of cortisol, prolactin, glucose and insulin. Additional samples were obtained 30 min after the start of surgery (T(1)), and 60 min after the end of surgery (T(2)). All of the basal values (T(0)) were within the normal ranges of the authors' laboratory for children of this age group and there were no differences between the groups (P > 0.05). In both groups, glucose concentration increased at T(1), compared with T(0) and T(2) (P < 0.05). The glucose concentration was unchanged at T(2) compared with T(0) in both group (P > 0.05). In both groups, prolactin concentration increased at T(1), compared with T(0) and decreased at T(2), compared with T(1) (P < 0.05). Cortisol decreased at T(1) and T(2), compared with T(0) in both groups. (P < 0.05). Insulin concentration remained unchanged at T(0) and T(2), but increased slightly at T(1) in both groups (P > 0.05). There were no significant differences in plasma prolactin, cortisol, glucose and insulin levels between the two groups at T(1) and T(2) (P > 0.05). There is no advantage in adding 0.5 microg/kg sufentanil to bupivacaine over bupivacaine alone in the caudal block, with regard to the surgical stress response in children.

Sufentanil does not enhance the efficacy of ropivacaine in combined lumbar plexus and sciatic block: A controlled, randomised clinical trial

Summary To date, data on the efficacy of the combination of opioids and local anesthetics in peripheral nerve block are not conclusive yet. In this study, the onset time, duration as well as quality of lumbar plexus and sciatic nerve blockade were evaluated using sufentanil and ropivacaine combination compared with plain ropivacaine. Forty patients scheduled for lower extremity surgery under combined lumbar plexus and sciatic nerve block were randomly allocated into two groups. Fifty millilitres of 0.375% ropivacaine with 0.5 μg/ml sufentanil (trial group) and 0.375% plain ropivacaine (control group) were administered when the location of lumbar plexus and sciatic nerve were confirmed by a nerve stimulator. Onset and duration of sensory and motor block were investigated. Opioid-related side effects were recorded. Quality of anesthesia in terms of success rate of block and patients’ satisfaction were reviewed after surgery. The addition of sufentanil to ropivacaine did not facilitate the onset of the block, nor the duration of analgesia. For lumbar plexus block, the mean onset time of sensory block was 13.9 ± 7.4 min (trial group) versus 12.4 ± 5.9 min (control group), respectively, 11.3 ± 6.5 min versus10.5 ± 4.2 min, respectively, for motor block. For sciatic nerve block, the onset time of sensory block was 14.6 ± 8.6 min versus 14.2 ± 7.0 min, respectively, 15.4 ± 7.3 min versus 13.6 ± 9.5 min, respectively, for motor block. The mean duration of sensory block is 14.3 ± 4.5 h (trial group) versus 15.2 ± 4.6 h (control group), respectively; the mean duration of motor block 17.3 ± 6.1 h versus 16.7 ± 5.3 h, respectively. Opioid-related side effects were similar between groups, as well as the success rate of the block and patients’ satisfaction. We concluded that, during combined lumbar plexus and sciatic nerve block, adding sufentanil 0.5 μg/ml to 0.375% ropivacaine solution did not provide clinically relevant advantages in terms of onset time, duration and quality of anesthesia for patients undergoing elective lower extremity surgery.