Doses Of Sufentanil Research Articles

Effective doses 50% and 95% of subarachnoid injection of sufentanil with ropivacaine in lumbar anesthesia for cesarean section in severe preeclampsia

Objective: This study aimed to determine the ED50 and ED95 of 10 mg of 0.5% ropivacaine combined with different doses of sufentanil in lumbar anesthesia for cesarean sections in patients with severe preeclampsia by the sequential method. Methods: A total of 47 patients with severe preeclampsia, who underwent cesarean section, were enrolled in the present study. The first patient was given a subarachnoid injection of 10 mg of isobaric 0.5% ropivacaine plus 2.5 μg of sufentanil. If the anesthetic effect was satisfactory, the dose of sufentanil used for the next patient was reduced by 0.5 μg. If the anesthetic effect was unsatisfactory, the dose of sufentanil used for the next patient was increased by 0.5 μg. Results: The ED50 of sufentanil was 1.830 μg, with a 95% CI ranging within 1.517-2.128 μg, while the ED95 of sufentanil was 2.852 μg with a 95% CI ranging within 2.429-4.338 μg. Conclusion: The ED50 and ED95 of 10 mg of isobaric 0.5% ropivacaine combined with different doses of sufentanil in lumbar anesthesia for cesarean sections in patients with severe preeclampsia were 1.830 μg and 2.852 μg, respectively.

Impact of anesthesia methods on perioperative systemic inflammation and long-term outcomes in patients undergoing surgery for hepatocellular carcinoma: a propensity score-matched analysis.

BackgroundRecent studies have shown regional anesthesia might improve the survival of cancer patients. We hypothesized that general-epidural anesthesia (GEA) was associated with longer survival than general anesthesia (GA) in patients undergoing hepatocellular carcinoma (HCC) resections.MethodsA retrospective study included patients who received curative resection for HCC between January 2014 to December 2017. Patients were grouped in GEA vs. GA. After propensity score matching, perioperative inflammatory scores were calculated. Grade of postoperative complications, length of stay (LOS), dosage of sufentanil used and times of patients requiring rescue analgesia in both groups were compared for intraoperative and postoperative parameter. Survival curves were constructed from the date of surgery to death, univariable and multivariable Cox regression models were used to compare hazard ratios for death.ResultsA total of 772 patients were included in the study. With 386 patients in GA group and 386 patients in GEA group. After propensity score matching, the demographic and baseline biomarkers in the two groups were similar. Patients in GEA group showed significantly lower inflammatory scores. Grade of postoperative complications, LOS, opioid use, and times of patients requiring rescue analgesia was significantly lower in the GEA group. The overall survival (OS) and disease-free survival (DFS) rate was significantly lower in the GA group (54.2% vs. 62.3%, 41.2% vs. 52.5%, P<0.001). The multivariate analysis indicated the GA was associated with shorter OS (HR: 1.28, 95% CI: 1.07–2.02, P<0.001) and DFS (HR: 1.06, 95% CI: 1.03–1.71, P<0.001).ConclusionsGA combined with epidural anesthesia is associated with lower levels of inflammation, and longer survival in patients undergoing hepatectomy.

Minimum Alveolar Concentration of Sevoflurane as a Single Hypnotic Agent to Maintain BIS Below 50 in Patients During Normothermic Cardiopulmonary Bypass

Minimum alveolar concentration (MAC) of volatile anesthetic agents to maintain bispectral index (BIS) below 50 in 50% of patients was defined as MACBIS50. The primary objective of this study was to determine the minimum alveolar concentration of sevoflurane as a single hypnotic agent to maintain BIS below 50 in patients during normothermic cardiopulmonary bypass. Prospective and observational study. Dante Pazzanese Institute of Cardiology, Brazil. Eighteen consecutive patients scheduled for elective coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) under general anesthesia, American Society of Anesthesiologists physical status classes III and IV, between the ages of 40 and 70, were included in the study. All patients underwent inhalation induction with facial mask using sevoflurane (Cristália) in 100% oxygen, pancuronium (Cristália) 0.1 mg/kg, and sufentanil (Cristália) 0.5 µg/kg intravenously (IV) administered. A single bolus dose of sufentanil, 1.0 µg/kg IV, was administered before surgical incision. MACBIS50 was calculated using the midpoint concentration of patients involving a crossover (BIS < or ≥50) according to Dixon's Up-and-Down method. The Up-and-Down sequence also was analyzed by probit test that enabled the authors to obtain the effective dose 50 (ED50) and effective dose 95 (ED95) of sevoflurane to maintain a BIS value <50, with a 95% confidence interval (95% CI) of the mean. A total of 15 patients were analyzed in this study. MACBIS50 of sevoflurane as a single hypnotic agent was 0.82% (95% CI 0.47-1.16) in patients aged 40 to 70 undergoing CABG during normothermic CPB. The ED50 and ED95 of sevoflurane to maintain a BIS value <50 for the same context were 0.73% (95% CI 0.45-1.00) and 1.39 (95% CI 0.42-2.37) by means of probit analysis, respectively. MACBIS50 of sevoflurane as a single hypnotic agent was 0.82% in patients undergoing CABG during normothermic CPB.

Use of BRASS in sedated critically-ill patients as a predictable mortality factor: BRASS-ICU

ABSTRACT Objectives: To demonstrate that a BRASS score≥ 3 at admission of intubated, ventilated and sedated patients is predictive of mortality Methods: we have realized an Observational prospective multicenter study. All Major patients without neurological history, admitted to ICU for a non-neurological cause, sedated and admitted under mechanical ventilation were included. Results: One hundred and ten patients were included, the BRASS score as well as the FOUR and RASS scores were collected. At day 28, patients with a BRASS score ≥ 3 had an excess mortality (OR 3.29 – CI 95% [1.42–7.63], p = 0.005) as well as day 90 (OR 2.65 – CI 95% [1.19–5.88], p = 0.02), without impact on the delirium measured by CAM-ICU (OR 1.8 – CI 95% [0.68–4.77], p = 0.023). After adjustment with SAPS II, FOUR and RASS, difference in mortality was not any more different. It is also noted that patients with BRASS ≥ 3 are more sedated (RASS: −5 [−5 – −5] vs −4 [−5 – −3], p < 0.0001) and more comatose (FOUR: 2 [1–4] vs 6 [4–9], p < 0.0001), and have higher doses of midazolam (10 mg/h [5–15] vs 7.5 mg/h [5–10], p = 0.02) and sufentanil (20 μg/h [15–22.5] vs 10 [10–12.5], p = 0.01). Conclusions: The early alteration of brainstem reflexes measured by the BRASS score was not independently predictable in terms of mortality in the non-neurological ICU patients, admitted under sedation and mechanical ventilation. Trial registration: ClinicalTrials.gov Identifier: NCT03835091,Registered 8 February 2019 – prospectively registered, https://clinicaltrials.gov/ct2/show/NCT03835091

Effect of magnetic beads auricular point sticking therapy on intrapartum fever in primipara with epidural labor analgesia

To observe effect of magnetic beads auricular point sticking therapy on intrapartum fever in primipara with epidural labor analgesia and explore its possible mechanism. A total of 160 primipara were randomly divided into an observation group (80 cases, 12 cases dropped off ) and a control group (80 cases, 15 cases dropped off ). The primipara in the control group received epidural labor analgesia. In the observation group, 15 min after epidural labor analgesia was performed, magnetic beads auricular point sticking therapy was given at shenmen (TF4), neishengzhiqi (TF2), neifenmi (CO18) and jiaogan (AH6a), pressing and kneading once every 15 min, 1 min each time, until the end of first stage of labor. The tympanic temperature on Ta (before labor analgesia), Tb (2 h after labor analgesia), Tc (4 h after labor analgesia) and Td (1 h after labor) was recorded, and the intrapartum fever incidence and level of serum cortisol and IL-6 between two groups were compared. The visual analogue scale (VAS) score before and after labor analgesia, the pressing times of patient controlled epidural analgesia (PCEA), and the dosage of sufentanil were observed. The active labor period, the second stage of labor, and the time of analgesia, the use of oxytocin, the number of vaginal examination and the rate of cesarean section were recorded in the two groups. There was no significant difference in tympanic temperature in the observation group at each time point (P>0.05), the tympanic temperature at Tc and Td in the control group was higher than that at Ta (P<0.05); the tympanic temperature at Tc and Td in the observation group was lower than that in the control group (P<0.05). The levels of serum cortisol and IL-6 at Td in the two groups were higher than those at Ta (P<0.05), and those in the observation group were lower than the control group (P<0.05). The second stage of labor in the observation group was shorter than that in the control group (P<0.05), and the pressing times of PCEA, the dosage of sufentanil, intrapartum fever incidence, usage rate and total amount of oxytocin and the number of vaginal examinations were all lower than those in the control group (P<0.05). Magnetic beads auricular point sticking therapy can reduce the amount of anesthetics, decrease the effect of epidural analgesia on primipara's body temperature regulation and labor progress, and lower the incidence of fever during labor analgesia by regulating the level of inflammatory response in the primipara.

Interaction of Analgesic Effects of Dezocine and Sufentanil for Relief of Postoperative Pain: A Pilot Study.

PurposeThe combination of dezocine and sufentanil is often used for postoperative analgesia in China and other areas, but the interaction of both two drugs is still unclear. The purpose of this study was to evaluate the interaction of the analgesic effects of dezocine and sufentanil in the patients after gynecological laparoscopic surgery.Patients and MethodsWe conducted a prospective, randomized, double-blinded clinical trial. A total of 150 patients were divided into 5 groups (30 in each group) in the post-anesthesia care unit, namely, dezocine group (Group D), sufentanil group (Group S) and dezocine mixed sufentanil groups (Group DS1-3). In group D and S, the initial dose of dezocine or sufentanil was 5mg and 5μg intravenously, respectively. In Group DS1, the initial dose was dezocine 5mg × 3/4 and sufentanil 5μg × 1/4. In Group DS2, the initial dose was dezocine 5mg × 1/2 and sufentanil 5μg × 1/2. In Group DS3, the initial dose was dezocine 5mg × 1/4 and sufentanil 5μg × 3/4.ResultsThe median effective dose (ED50) of dezocine and sufentanil alone was 3.92 (95% confidence interval (CI) 3.01~4.64) mg and 3.71 (95% CI 2.78~4.39) μg, respectively. The isobolographic analysis showed that the combination of dezocine and sufentanil at 1:3, 1:1 or 3:1 appeared in the additive line.ConclusionIn conclusion, when simultaneously administered intravenously, combined dezocine and sufentanil produce an additive effect for relieving the acute nociception after gynecological laparoscopic surgery.

A beat-by-beat cardiovascular index, CARDEAN, to titrate opioid administration in the setting of orthopaedic surgery: a prospective randomized trial.

To determine whether a beat-by-beat cardiovascular index (CARDEAN: cardiovascular depth of analgesia, Alpha-2 Ltd, Lyon, France) reduces the incidence of tachycardia in ASA I-III patients undergoing orthopaedic surgery. A total of 76 patients were prospectively randomized into (1) a control group or (2) the CARDEAN group, in which the nurse anaesthetist was blinded to CARDEAN application. In addition to conventional signs, an external observer instructed the nurse anaesthetist to administer sufentanil 0.1µgkg-1 when the CARDEAN crossed a threshold (≥60). The primary outcome was the incidence of tachycardia (>120% of reference heart rate, HR). Non-invasive blood pressure (BP), electrocardiogram (ECG), O2 saturation-photoplethysmography and the bispectral index (40<BIS<60) were monitored. HR and an estimation of beat-by-beat BP changes acquired from photoplethysmography and ECG were combined in an algorithm that detected hypertension followed by tachycardia (index scaled 0-100). Sufentanil 0.1µgkg-1 was administered when tachycardia, hypertension or movement ("conventional signs") was observed. Data for 66 patients (27 with known hypertension) were analysed. In the CARDEAN group, (a) the dose of sufentanil was higher (control: 0.46µgkg-1100min-1, CARDEAN: 0.57µgkg-1100min-1, p=0.016), (b) the incidence rates of tachycardia and untoward events were lower (respectively: -44%; control: 2.52 events100min-1 [1.98-3.22]; CARDEAN: 1.42 [1.03-1.96], p=0.005, hazard ratio: 0.56; movement, muscular contraction, or coughing: control: 0.74 events100min-1 [0.47-1.16]; CARDEAN: 0.31 [0.15-0.62], p=0.038), and (c) extubation occurred more often in the operating room (control: 76.5%, CARDEAN: 97%, p=0.016). CARDEAN-titrated opioid administration was associated with a higher dose of sufentanil, a reduction in tachycardia and earlier emergence in ASA I-III patients undergoing major orthopaedic surgery.

Risk of Postoperative Hyperalgesia in Adult Patients with Preoperative Poor Sleep Quality Undergoing Open-heart Valve Surgery.

PurposeStudies have reported that preoperative poor sleep quality could decrease the pain threshold in patients undergoing noncardiac surgery. However, the risk of postoperative hyperalgesia (HA) in cardiac surgery patients with preoperative poor sleep quality remains unclear.Patients and MethodsWe retrospectively collected clinical data from patients undergoing open-heart valve surgery between May 1 and October 31, 2019, in Fuwai Hospital (Beijing). We assessed preoperative sleep quality and postoperative pain severity using the Pittsburgh sleep quality index (PSQI) and numerical pain rating scale (NPRS), respectively. A PSQI of six or greater was considered to indicate poor sleep quality, and a NPRS of four or greater was considered to indicate HA. Multivariable logistic regression analysis was used to study the risk of postoperative HA in patients with preoperative poor sleep quality.ResultsWe divided 214 eligible patients into two groups based on postoperative HA; HA group: n=61 (28.5%) and nonHA group: n=153 (71.5%). Compared with nonHA patients, patients with postoperative HA showed a higher percentage of history of smoking, 17 (11.1%) vs 15 (24.6%) and alcohol abuse, 5 (3.3%) vs 6 (9.8%), higher intraoperative dose of sufentanil (median, 1.02 vs 1.12 μg/kg/h), and longer duration of ventilation with tracheal catheter (median, 760 vs 934 min). Preoperative poor sleep quality was associated independently with an increased risk of postoperative HA (adjusted odds ratio [AOR]: 2.66; 95%CI: 1.31–5.39, P=0.007). Stratification by history of smoking revealed a stronger risk of postoperative HA in nonsmoking patients with preoperative poor sleep quality (AOR: 3.40; 95%CI: 1.51–7.66, P=0.003). No risk was found in patients who had history of smoking (AOR: 0.83; 95%CI: 0.14–4.75, P=0.832).ConclusionPreoperative poor sleep quality is an independent risk factor for postoperative HA in adult patients undergoing open-heart valve surgery who had no history of smoking.

Effects of ultrasound-guided erector spinae plane block on postoperative analgesia and plasma cytokine levels after uniportal VATS: a prospective randomized controlled trial

Although uniportal video-assisted thoracoscopic surgery (VATS) has been widely used, the associated postoperative pain is still severe. Currently, a variety of regional anesthesia methods have been used to relieve postoperative pain. In our study, we wanted to evaluate the effectiveness of ultrasound-guided erector spinae plane block (ESPB) as a postoperative analgesia after uniportal VATS. Eighty patients scheduled to undergo uniportal VATS were randomly divided into Group ESP and Group C. In Group ESP, the patients underwent ultrasound-guided ESPB under general anesthesia before surgery, while Group C was set as blank control group without ESPB. The primary outcome was the sufentanil dose within 24h after surgery. The secondary outcomes mainly included postoperative pain scores at 2, 4, 8, and 24h evaluated using a numeric rating scale (NRS), intraoperative opioid dosage, levels of inflammatory cytokines, including tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and interleukin-10 (IL-10) in the plasma, side effect profile, and length of postoperative hospital stay. Postoperative sufentanil consumption (32.5 ± 6.3μg vs. 42.8 ± 7.6μg, P < 0.001) was significantly lower in Group ESP than in Group C. Intraoperative sufentanil consumption was significantly lower in Group ESP than in Group C (P < 0.001). The postoperative NRS score and levels of inflammatory cytokines were significantly lower in Group ESP than in Group C (P < 0.05). Ultrasound-guided ESPB decreased the consumption of sufentanil both postoperatively and intraoperatively for patients undergoing uniportal VATS and appeared to be an effective treatment option.

Ketorolac tromethamine pretreatment suppresses sufentanil-induced cough during general anesthesia induction: a prospective randomized controlled trial

BackgroundTo observe the effect of pretreatment with ketorolac tromethamine on sufentanil-induced cough in general anesthesia patients.MethodsA total of 102 patients were screened, and 90 patients were scheduled for elective surgery under general anesthesia. The 90 patients were randomly divided into two groups: the control group (C group) and the observation group (KT group). Five minutes before anesthesia induction, the observation group was given ketorolac tromethamine 0.5 mg/kg intravenously within 3 s, while the control group was given the same amount of normal saline intravenously. All patients were given a sufentanil bolus of 0.5 μg/kg (within 3 s) intravenously. One minute later, propofol 2.5 mg/kg and vecuronium 0.15 mg/kg were injected intravenously, and endotracheal intubation was guided by laryngoscopy. The number of coughs that occurred within 1 min after sufentanil injection was recorded. The mean arterial pressure (MAP), heart rate (HR) and pulse oxygen saturation (SpO2) were recorded at T0 (immediately before pretreatment), T1 (5 min after pretreatment), T2 (before intubation), T3 (1 min after intubation) and T4 (5 min after intubation). The incidence of adverse reactions, including nausea and vomiting, dizziness, drowsiness, delay of recovery, restlessness in the recovery period, respiratory depression and postoperative incision pain, was analyzed.ResultsWithin 1 min after sufentanil injection, the incidence and severity of cough in the KT group was significantly lower than that in the C group (P < 0.05). At T0, T1, T2, T3 and T4, there were no significant differences in MAP, HR and SpO2 between the two groups (P > 0.05). There was no significant difference in the dosage of sufentanil, propofol, remifentanil and vecuronium, the incidence of nausea and vomiting, the delay of recovery, dizziness, drowsiness or respiratory depression between the two groups (P > 0.05). However, the incidence of restlessness and the number of patients with VAS scores > 3 in the KT group were significantly lower than those in the C group (P < 0.05).ConclusionPretreatment with intravenous ketorolac tromethamine can significantly reduce the incidence of sufentanil-induced cough during induction of general anesthesia, which can also significantly reduce postoperative incision pain and restlessness during the recovery period.Trial registrationChinese Clinical Trial Registry (registration number# ChiCTR2000030287; date of registration: 27/02/2020).

Effects of continuous endotracheal-laryngopharynx topical anesthesia on the general anesthetic requirements during surgery.

The purpose of this study was to investigate the general anesthetic requirements in patients with continuous endotracheal-laryngopharynx topical anesthesia using medicine injecting endotracheal tube during surgery. A total of 78 patients with American Society of Anesthesiologists (ASA) physical status I–II were randomly divided into test group and control group. After anesthesia, patients were injected by 1.5 mL of 1% Tetracaine for topical anesthesia, and later injected similarly at hourly intervals during surgery while patients in control group were non-injected. There was no statistical significance in values of SBP, DBP, MAP, HR and plasma concentrations of E, NE and Cor at same time point between the two groups during operation (P>0.05). There was no statistical significance in value of BIS at T0-T5 between the two groups (P>0.05). However, value of BIS at T6 in test group was significantly higher than that in control group (69.7±2.1 vs. 58.6±2.3, P<0.01). Doses of sevoflurane, propofol sufentanil and cisatracurium used up in test group decreased by 12.3% (P<0.01); 12.7% (P<0.01); 14.5% (P<0.01) and 4.9% (P>0.05) than those in control group, respectively. Continuous endotracheal-laryngopharynx topical anesthesia using 1% Tetracaine via medicine-injecting endotracheal tube can significantly decrease general anesthetic requirements of surgery.

The Effect of a Small Priming Dose of Sufentanil on Sufentanil-Induced Cough

PurposeThe aim of this study was to investigate the effect of a small priming dose of sufentanil on sufentanil-induced cough during induction of anesthesia. DesignRandomized controlled trial. MethodsAdult patients (N = 220) aged 18 to 65 years undergoing general anesthesia were randomized into two groups (n = 110), a total dose of sufentanil 0.4 mcg/kg was used during induction of anesthesia. Group P (intervention) received a bolus of 5 mcg of sufentanil 1 minute before a bolus of the remaining larger dose of sufentanil, whereas group C (comparison) received an equal volume of normal saline 1 minute before a bolus of the total dose of sufentanil. The incidence and severity of cough were noted for 1 minute after each injection of sufentanil or normal saline. FindingsThe incidence of cough in group P was significantly lower than group C (6.4% vs 21.8%, P < .001). The severity of cough in group P was significantly decreased compared with group C (P < .001). In group P, three patients (2.7%, P = .247) coughed after the priming sufentanil injection. ConclusionsA priming dose of 5 mcg of sufentanil 1 minute before a larger dose of sufentanil injection could effectively alleviate sufentanil-induced cough, the small priming dose of sufentanil could also elicit cough with a low incidence.

Genetic Polymorphisms of Cytokines Might Affect Postoperative Sufentanil Dosage for Analgesia in Patients.

ObjectiveTo explore the effect of genetic polymorphisms of cytokines on the dosage of sufentanil for patient-controlled intravenous analgesia (PCIA) after radical lung cancer surgery.MethodsA total of 100 patients, aged 18 years and above, with ASA grade Ⅰ-Ⅱ and body mass index (BMI) 18.5 to 30, and who were scheduled for radical lung cancer surgery under total intravenous anaesthesia with PCIA of sufentanil from September 2015 to March 2016, were selected. DNA was collected from peripheral blood samples before surgery, and the iMLDRTM multiple single-nucleotide polymorphism typing kit was used to detect 16 related single-nucleotide polymorphism (SNP) sites of interleukin-1A (IL-1A), interleukin-1β (IL-1β), interleukin-1RN (IL-1RN), interleukin-6 (IL-6), C-X-C motif chemokine ligand 8 (CXCL8), interleukin-10 (IL-10), tumour necrosis factor (TNF), nuclear factor kappa-B1 (NFκB1), REL (REL proto-oncogene, NF-kB subunit), and nuclear factor kappa-B inhibitor alpha (NFκBIA). The general characteristics of patients, surgery and anaesthesia data, postoperative resting VAS pain scores, postoperative opioid dosages of sufentanil for PCIA and opioid-related adverse events were recorded. The effects of the examined genetic polymorphisms of the cytokines on the dosage of sufentanil were analysed.ResultsEight of 100 patients withdrew for various reasons, and, eventually, 92 patients were included. The patients’ resting visual analogue scale (VAS) scores at 24 h, 48 h, and 72 h after surgery were 2.3 ± 1.2, 2.0 ± 0.9, and 1.9 ± 1.0, respectively. The total amounts of sufentanil used were 34.7 ± 10.5 μg, 65.2 ± 13.7 μg, and 94.7 ± 11.6 μg, respectively. We found that the TT genotype of NFκBIA rs696 had higher PCIA sufentanil dosages than the CC genotype and the CT genotype at 48–72 h postoperation (p=0.023, p=0.025, respectively).ConclusionThe genetic polymorphisms of the cytokine NFκBIA rs696 might affect the dosage of sufentanil for PCIA after radical lung cancer surgery. The specific mechanism needs further study.

Comparison of ED95 of Butorphanol and Sufentanil for gastrointestinal endoscopy sedation: a randomized controlled trial

BackgroundButorphanol, a synthetic opioid partial agonist analgesic, has been widely used to control perioperative pain. However, the ideal dose and availability of butorphanol for gastrointestinal (GI) endoscopy are not well known. The aim of this study was to evaluated the 95% effective dose (ED95) of butorphanol and sufentanil in GI endoscopy and compared their clinical efficacy, especially regarding the recovery time.MethodsThe study was divided into two parts. For the first part, voluntary patients who needed GI endoscopy anesthesia were recruited to measure the ED95 of butorphanol and sufentanil needed to achieve successful sedation before GI endoscopy using the sequential method (the Dixon up-and-down method). The second part was a double-blind, randomized study. Two hundred cases of painless GI endoscopy patients were randomly divided into two groups (n = 100), including group B (butorphanol at the ED95 dose) and group S (sufentanil at the ED95 dose). Propofol was infused intravenously as the sedative in both groups. The recovery time, visual analogue scale (VAS) score, hand grip strength, fatigue severity scores, incidence of nausea and vomiting, and incidence of dizziness were recorded.ResultsThe ED95 of butorphanol for painless GI endoscopy was 9.07 μg/kg (95% confidence interval: 7.81–19.66 μg/kg). The ED95 of sufentanil was 0.1 μg/kg (95% CI, 0.079–0.422 μg/kg). Both butorphanol and sufentanil provided a good analgesic effect for GI endoscopy. However, the recovery time for butorphanol was significantly shorter than that for sufentanil (P < 0.05, group B vs. group S:21.26 ± 7.70 vs. 24.03 ± 7.80 min).ConclusionsButorphanol at 9.07 μg/kg was more effective than sufentanil for GI endoscopy sedation and notably reduced the recovery time.Trial registrationChinese Clinical Trail Registry (Registration number # ChiCTR1900022780; Date of Registration on April 25rd, 2019).

Perioperative Analgesic Effects of Preemptive Ultrasound-Guided Rectus Sheath Block Combined with Butorphanol or Sufentanil for Single-Incision Laparoscopic Cholecystectomy: A Prospective, Randomized, Clinical Trial.

PurposePain after single-incision laparoscopic cholecystectomy (SILC), especially visceral pain, often troubles patients and doctors. Whether preemptive butorphanol can relieve visceral pain in patients undergoing SILC remains unknown. The goal of this study was to assess the efficacy of ultrasound-guided bilateral rectus sheath block (RSB) and butorphanol for perioperative analgesia in patients undergoing SILC.Patients and MethodsFifty-eight patients who met the criteria were randomly divided into two groups, both of which were given preemptive RSB. Patients were given either butorphanol 0.02mg/kg (group B, n=29) or sufentanil 0.1 µg/kg (group S, n=29) as preemptive analgesia. The primary outcome was the cumulative frequency of rescue analgesic request within 24 hours after operation. Secondary outcomes were numeric rating scale (NRS) scores (from 0 to 10) of incisional pain and visceral pain, the length of hospital stay and the incidence of postoperative adverse events.ResultsThe frequency of postoperative rescue analgesic request of group S was significantly higher than that of group B (P=0.021). The NRS scores for visceral pain were lower in group B at 2, 6 and 12 hours after surgery than in group S (both P<0.001). The occurrence of postoperative nausea and vomiting (PONV) was significantly higher in group S. There were no significant differences between two groups for other outcomes.Conclusion Butorphanol can provide sufficient visceral pain treatment after SILC than the dose of sufentanil in equal analgesic effect.

Guiding Opioid Administration by 3 Different Analgesia Nociception Monitoring Indices During General Anesthesia Alters Intraoperative Sufentanil Consumption and Stress Hormone Release: A Randomized Controlled Pilot Study.

This pilot study investigated the effect of sufentanil titration by 3 different analgesia monitoring devices or clinical signs during general anesthesia. Forty-eight patients undergoing radical retropubic prostatectomy with sevoflurane/sufentanil anesthesia were randomly assigned into 4 groups and received sufentanil guided either by 1 of 3 analgesia monitoring devices (Surgical Pleth Index [SPI], Pupillary Pain Index [PPI], Nociception Level [NoL]) or by clinical judgment (control). The primary end point was intraoperative sufentanil consumption. Adrenocorticotropic hormone (ACTH) and cortisol were measured at 4 time points during the day of surgery. Data were analyzed by Kruskal-Wallis and Mann-Whitney U tests and by mixed model and area under the curve (AUC) analyses for group comparisons and time effects of stress hormones. The total amount of sufentanil administration (μg·kg·minute·10) differed between the groups (median [quartiles]: control = 5.6 [4.4-6.4], SPI = 7.2 [4.8-8.4], PPI = 2.0 [1.8-2.9], NoL = 3.8 [3.3-5.1]; PPI versus SPI, -5.1 [-6.6 to -1.3], P < .001; NoL versus SPI, -3.0 [-5.2 to 0.2], P = .024; control versus SPI, -1.6 [-3.7 to 1.7], P = .128; NoL versus PPI, 1.7 [0.6-3.4], P < .001; control versus PPI, 3.4 [2.0-4.6], P < .001; control versus NoL, 1.6 [-0.2 to 3.3], P = .017) (Hodges-Lehmann estimator [99% confidence interval {CI}], P values). The AUC analysis indicated differences among groups in cumulative ACTH levels (ng·liter·minute, natural logarithm (ln)-transformed data) of NoL versus PPI (-1.079 [-1.950 to -0.208], P = .001) and PPI versus SPI (1.192 [0.317-2.068], P= .001), as well as differences in cortisol levels (µg·liter·minute) for PPI versus SPI (46,710 [21,145-72,274], P < .001), NoL versus SPI (27,645 [3163-52,126], P = .003), and control versus SPI (31,824 [6974-56,675], P = .001) (differences in means [99% CI], P value). Secondary end points (postoperative recovery, pain level, and analgesia medication) showed no differences. The type of analgesia nociception monitoring affected the total amount of sufentanil administered. Lower sufentanil doses in the PPI group were associated with an increased endocrine stress response. Titration by SPI caused no opioid reduction compared to the control but was associated with a reduced endocrine stress response.

A Randomized Controlled Comparison of Epidural Analgesia Onset Time and Adverse Reactions During Labor With Different Dose Combinations of Bupivacaine and Sufentanil.

The purpose was to compare the effects of 3 different dose combinations of bupivacaine and sufentanil on the onset of analgesia and the occurrence of side effects. One hundred sixty-nine pregnant women were randomly assigned to 3 groups: the B1S5 group received 0.1% bupivacaine+5 μg sufentanil in 15 mL; the B125S5 group received 0.125% bupivacaine+5 μg sufentanil in 15 mL; and the B1S10 group received 0.1% bupivacaine+10 μg sufentanil in 15 mL. The primary outcome was the analgesic onset time, and the secondary outcomes were mode of delivery, patient satisfaction, maternal and neonatal side effects (pruritus, hypotension, sedation, motor block, decreased fetal heart rate, fever, and interference with breastfeeding). The median (inter-quartile range) time to achieve effective analgesia was significantly faster in the B125S5 group than in the B1S5 group (10 [11-14 {4-30}] min vs. 15 [17-20 {5-30}] min, P<0.001). There was no significant difference in the analgesia onset time between the B1S10 and B125S5 groups (10 [11-14 {4-30}] min vs. 12 [13-15 {3-30}] min, P=0.202). Pruritus, hypotension, motor block, maternal satisfaction, delivery mode, decreased fetal heart rate, total bupivacaine dose and breastfeeding scores were not significantly different among the 3 groups except the sufentanil dosage and incidence of mild drowsiness and fever (the B1S10 group had significantly higher fever than the other groups). The B125S5 combination may be superior to the B1S5 and B1S10 combinations as an initial dose for epidural analgesia to achieve rapid effective analgesia with minimal side effects.

Effects of menstrual cycle on nausea and vomiting after general anesthesia.

To investigate the impact of menstrual cycle on patients undergoing gynecological endoscopic surgery. 220 patients scheduled for gynecological endoscopic surgery under general anesthesia were selected. The patients were divided into three groups based on 3 phases of menstrual cycle which are the follicular phase (Group F), ovulatory phase (Group O) or luteal phase (Group L). It is based on their duration of menstruation and the last day of menstrual bleeding from the date of surgery. Primary outcomes were the incidences of early and late postoperative nausea and vomiting (PONV) in the three patient groups. Preoperative venous blood was taken to determine the estrogen and progesterone levels of the patients. A total of 207 patients were enrolled. The incidence of early PONV was highest in group O (22.22% vs 43.33% vs 17.86%, P < 0.01). Multivariate logistic regression showed that menstrual cycle (P < 0.01) and sufentanil dosage (P < 0.05) were independent risk factors for early PONV, menstrual cycle (P = 0.03) and intraoperative hypotension (P = 0.03) were independent risk factors for late PONV. After the propensity matching, the incidences of early and late PONV in group O were both higher than that in other two groups (19.23% vs 44.68% vs 16.90%, P < 0.01; 53.80% vs 72.34% vs 45.07%, P = 0.01). The incidence of PONV after gynecological endoscopic surgery was different in patients with different menstrual cycles, with the highest incidence in ovulation.

Effect and safety of electroacupuncture analgesia at the latent stage of labor on the epidural analgesia

To investigate the effect of electroacupuncture (EA) analgesia at the latent stage of labor on epidural analgesia, labor outcome and neonatal score so as to provide the reference to the clinical labor analgesia. According to the random number table, 104 primipara of vaginal delivery were divided into three groups, named an EA group (37 cases), a sham-EA group (36 cases) and an epidural block group (31 cases). In the EA group, when the cervix opened up by 1 cm, Han's acupoint nerve stimulation apparatus was attached to bilateral Hegu (LI4) and bilateral Sanyinjiao (SP6) to achieve EA analgesia till the active stage (the cervix up 3 cm). In the sham-EA group, the procedure was same as the EA group, but with the sham-stimulation. In the epidural block, EA was not used in intervention. When the cervix opened up 3 cm, the epidural block and the patient-controlled epidural analgesia were all adopted in each group. The score of visual analogue scale (VAS) and the dosage of Sufentanil and Ropivacaine in patient-controlled analgesia pump at the different time points were compared among the groups. Respectively, in 1 h of EA stimulation (T1), 2 h of EA stimulation (T2), at the moment of epidural block (T3) and the complete open of the cervix (T6), the venous blood sample was collected to determine the concentration of beta-endorphin (beta-EP), and the use time of oxytocin, the bleeding amount and the state of newborn were recorded. There was no statistical difference in immediate of EA stimulation (T0) among the groups in VAS score (P>0.05). But, in T1 to T6, VAS score in the EA group was reduced obviously as compared with the sham-EA group and the epidural block group separately (P<0.05). There was no statistical difference in the use time of oxytocin among the three groups (P>0.05). In the sham-EA group and the epidural block group, bleeding amount during labor and in 24 h after labor was all higher than that of the EA group (P<0.05). In each group, the concentration of beta-EP in T3 and T6 was increased obviously as compared with that in T1 and T2 respectively (P<0.05). In the EA group, the concentration of beta-EP in T1 to T3 and in T6 was higher than that in sham-EA group and the epidural block group respectively (P<0.05). The dosage of Ropivacaine and Sufentanil in the EA group was less than that in either the sham-EA group or the epidural block group (P<0.05). There was no significant difference in amniotic fluid turbidity rate and Apgar score among the three groups (P>0.05). Electroacupuncture analgesia at the latent stage of labor effectively relieves labor pain of primipara, increases the concentration of beta-EP, enhances the effect of epidural block analgesia, reduces labor bleeding and has no side effect on newborn. The combination of electroacupuncture analgesia and the epidural anesthesia in the latent stage is applicable in the whole process of labor.

Effects of the Opioid Analgesic, Sufentanil, on Respiration after Extremity Trauma and Severe Conscious Hemorrhage in Rats

Background: Currently, opioid analgesics such as Sufentanil are not recommended for use on the battlefield for Soldiers with severe hemorrhage and respiratory difficulties, although they are still used during such situations (Schauer et al., Prehosp Emerg Care 21: 744, 2017). Moreover, there have been no controlled, preclinical studies conducted using analgesic doses of Sufentanil to support these guidelines. The current study was conducted to evaluate effects of the opioid analgesic Sufentanil on multiple components of respiration after severe hemorrhage in conscious rats in the absence or presence of extremity trauma. We hypothesized that Sufentanil would negatively impact respiration under such experimental conditions.MethodsRats were randomly assigned to receive either 0.9% saline vehicle (VEH), or 1μg/kg Sufentanil (SUF; 0.1μg/100 μl). These treatments were subdivided into rats that were (T) or were not (NT) exposed to trauma (n=9–10 rats/each of the 4 groups). All rats (male; ~ 380grams) were surgically implanted with a carotid catheter. After 24 hours, rats were anesthetized briefly (10 min) to undergo trauma (crushing of the right gastrocnemius and semimembranosus muscles for 30 sec with forceps, T) and fibula fracture. NT rats were anesthetized for 10 min only. Rats were allowed to awaken, and 90 min later underwent a conscious hemorrhage (~55% of blood volume during 25 min) within a whole body plethysmography chamber via the indwelling carotid catheter. At the end of hemorrhage, rats received either VEH or SUFvia the carotid catheter. Respiratory measures were collected and recorded over 1 min intervals and analyzed via Data Sciences International FinePointe software. Primary respiratory measures were respiration rate (RR; breaths/min), tidal volume (TV; ml), and minute volume (MV; ml/min; RR x TV). TV and MV were normalized to the average body weight of all rats used in the study (377 grams). Rats were observed for 1 hr after the start of the hemorrhage. Data were analyzed via multiway analysis of variance (ANOVA) for repeated measures using the Statistical Analysis System.ResultsFor RR, there was no effect of trauma (P = 0.43) so data were combined across T and NT groups for each treatment. For a brief period (2–15 min) after SUF injection, RR was lower (P &lt; 0.04) compared with VEH. For TV and MV, there were interactions between treatment and trauma groups. Hence, compared with VEH‐rats, TV in SUF‐rats was intermittently depressed in T‐rats (P &lt; 0.04) but briefly increased in NT‐rats (P &lt; .03) for up to 15 min post injection. In T‐rats only, SUF transiently (12 min) decreased MV (P&lt;0.05) starting 3 min after injection. All respiratory effects induced by SUF were resolved within 15 min.ConclusionsAt the analgesic dose given – previously shown to ameliorate behavioral indices of pain in rats (Xiang, J Trauma Acute care Surg 85: S49, 2018) – and at the times measured, SUF had primarily transient inhibitory effects on respiration that often depended on the presence of previous extremity trauma.Support or Funding InformationThis study was funded by the US Army Medical and Materiel Command, Clinical and Rehabilitative Medicine Research Program.