Sufentanil For Postoperative Analgesia Research Articles

Effect of Sufentanil Combined with Gabapentin on Acute Postoperative Pain in Patients Undergoing Intraspinal Tumor Resection: Study Protocol for a Randomized Controlled Trial.

PurposePatients undergoing intraspinal tumor resection usually experience severe postoperative pain. Inadequate postoperative analgesia usually leads to severe postsurgical pain, which could cause patients to suffer from many other related complications. Recently, an increasing number of studies have found that gabapentin can relieve hyperalgesia, postoperative pain, and postoperative inflammation. However, there have been no reports on the use of gabapentin combined with sufentanil preoperatively for acute pain following intraspinal tumor resection.Study Design and MethodsThis is a protocol for a randomized, placebo-controlled, and double-blinded trial. One-hundred and sixty-eight participants with chronic pain related to the intraspinal tumor will be randomized into the gabapentin and placebo groups in a 1:1 ratio. In the gabapentin group, patients will be given 300 mg gabapentin orally 36 h, 24 h, and 12 h before surgery; the placebo group will receive a placebo orally at the same time points preoperatively. To estimate the efficacy and safety endpoints, all the researchers and patients will be blinded until the completion of this study. The primary outcome will be the consumption of sufentanil within 48 h postoperatively. The secondary outcomes include the visual analog scale pain score and Von Frey mechanical pain threshold 36 h and 24 h before and 24 h and 48 h after surgery, the incidence of postoperative nausea, vomiting, and drowsiness, the length of hospital stay and medical expenses.DiscussionThis trial is to evaluate the efficacy and safety of gabapentin combined with sufentanil for postoperative analgesia in patients who complain of pain before intraspinal tumor resection. The findings will provide a new strategy for multimode perioperative analgesia management in these patients.

Predicting prolonged postoperative length of stay risk in patients undergoing lumbar fusion surgery: Development and assessment of a novel predictive nomogram.

ObjectiveThe purpose of this study was to develop and internally validate a prediction nomogram model in patients undergoing lumbar fusion surgery.MethodsA total of 310 patients undergoing lumbar fusion surgery were reviewed, and the median and quartile interval were used to describe postoperative length of stay (PLOS). Patients with PLOS > P75 were defined as prolonged PLOS. The least absolute shrinkage and selection operator (LASSO) regression was used to filter variables for building the prolonged PLOS risk model. Multivariable logistic regression analysis was applied to build a predictive model using the variables selected in the LASSO regression model. The area under the ROC curve (AUC) of the predicting model was calculated and significant test was performed. The Kappa consistency test between the predictive model and the actual diagnosis was performed. Discrimination, calibration, and the clinical usefulness of the predicting model were assessed using the C-index, calibration plot, and decision curve analysis. Internal validation was assessed using the bootstrapping validation.ResultsAccording to the interquartile range of PLOS in a total of 310 patients, the PLOS of 235 patients was ≤P75 (7 days) (normal PLOS), and the PLOS of 75 patients was > P75 (prolonged PLOS). The LASSO selected predictors that were used to build the prediction nomogram included BMI, diabetes, hypertension, duration of surgery, duration of anesthesia, anesthesia type, intraoperative blood loss, sufentanil for postoperative analgesia, and postoperative complication. The model displayed good discrimination with an AUC value of 0.807 (95% CI: 0.758–0.849, P < 0.001), a Kappa value of 0.5186 (cutoff value, 0.2445, P < 0.001), and good calibration. A high C-index value of 0.776 could still be reached in the interval validation. Decision curve analysis showed that the prolonged PLOS nomogram was clinically useful when intervention was decided at the prolonged PLOS possibility threshold of 3%.ConclusionsThis study developed a novel nomogram with a relatively good accuracy to help clinicians access the risk of prolonged PLOS in lumbar fusion surgery patients. By an estimate of individual risk, surgeons and anesthesiologists may shorten PLOS and accelerate postoperative recovery of lumbar fusion surgery through more accurate individualized treatment.

Preoperative Anxiety and Postoperative Pain in Patients With Laparoscopic Hysterectomy.

Objective: This study was designed to investigate preoperative anxiety situations and postoperative pain degree in Chinese patients undergoing laparoscopic hysterectomy and to analyze the related factors of preoperative anxiety and the correlation between preoperative anxiety and postoperative pain to provide a reference for effective postoperative analgesia management.Methods: A total of 100 female patients undergoing laparoscopic hysterectomy were enrolled in this study and randomly divided into two groups (n = 50, each). In group A, the patients were treated with dexmedetomidine and sufentanil for postoperative analgesia. In group B, the patients were treated with sufentanil alone for postoperative analgesia. All patients were evaluated with a self-rating anxiety scale (SAS) 1 day before the operation. The patients’ pain was evaluated using the numerical rating scale (NRS) 1 day after the operation, and data were recorded.Results: In these 100 patients, the highest preoperative SAS score was 48, and the average score was 40.99 ± 4.55 points, which is higher than the norm in China. There were significant differences in preoperative SAS scores among patients with different occupations and previous surgical experience (P < 0.05). There was no significant difference in SAS scores among patients with different education levels (P > 0.05). The postoperative NRS score of group A was significantly higher than that of group B, and the difference was statistically significant (P < 0.05). The correlation coefficients between SAS scores and NRS scores in groups A and B were 0.836 and 0.870, respectively, presenting with a significantly positive correlation.Conclusion: Preoperative anxiety is an important predictor of postoperative pain. Patients undergoing laparoscopic hysterectomy have preoperative anxiety. The degree of anxiety is influenced by the occupation and previous operation experience of the patients, and patients with higher preoperative anxiety have greater postoperative pain. In addition, we should not neglect the management of postoperative pain because of the small trauma of laparoscopic surgery, and dexmedetomidine combined with sufentanil can improve the postoperative analgesic effect.

The Effect and Optimal Dosage of Dexmedetomidine Plus Sufentanil for Postoperative Analgesia in Elderly Patients With Postoperative Delirium and Early Postoperative Cognitive Dysfunction: A Single-Center, Prospective, Randomized, Double-Blind, Controlled Trial.

BackgroundPostoperative delirium (POD) and postoperative cognitive dysfunction (POCD) are common complications after major surgery among elderly patients. Dexmedetomidine (DEX) is less frequently explored for its effects in patients with postoperative neurocognitive disorders. This study investigated the effect and optimal dosage of DEX for patient-controlled analgesia (PCA) on POD and early POCD after major surgery among elderly patients.MethodsPatients in four groups received continuous infusion of DEX 0, 100, 200, and 400 μg with sufentanil 150 μg for PCA immediately after surgery. POD and POCD were assessed on postoperative days 1, 2, 3, and 7 by using the Confusion Assessment Method (CAM) and Mini-Mental State Examination (MMSE) scales. Furthermore, the incidence of POD and POCD of all the four groups in postoperative 7 days classified by high risk factors (age, education, surgical site, and surgical category), sedation level, postoperative pain intensity, and side effects were assessed.ResultsThe overall incidence rates of POD and early POCD 7 days after surgery were lower in the DEX 200 μg 400 μg groups than in the DEX 0 μg and 100 μg groups (P < 0.05). Compared with DEX 200 μg, DEX 400 μg reduced early POCD in patients who underwent open surgery (P < 0.05). There were no intergroup differences in the postoperative sedation level, pain intensity, and side effects.ConclusionThe continuous infusion of DEX 200 μg or DEX 400 μg in PCA significantly decreased the incidence of POD and early POCD after major surgery without increasing any side effects. Compared with DEX 200 μg, DEX 400 μg was preferred for reducing early POCD in patients who underwent open surgery.

Effect of advanced analgesia with parecoxib sodium on the dosage of sufentanil for postoperative analgesia in patients underwent upper abdominal surgery

Objective To investigate the effect of piracoxib sodium on analgesia in patients with upper abdominal surgery, and to provide a reference for the choice of analgesia in these patients. Methods A total of 120 patients with abdominal surgery (stomach, liver, pancreas, spleen, etc.) were enrolled using computer random software, including 81 males and 39 females, 37-62 years old, BMI 17.6-24.2kg/m2, ASA grade I-II.They were randomly divided into parecoxib sodium group (P group) and control group (C group) using computer random software, 60 patients in each group.The two groups were treated with midazolam 0.05mg/kg, propofol 1-1.5mg/kg, rocuronium 0.6mg/kg, sufentanil 0.6μg/kg for anesthesia induction.TCI propofol 2-4mg·kg-1·h-1 and intermittent intravenous injection of sufentanil 0.1-0.2μg/kg, rocuronium 0.15-0.3mg/kg to maintain intraoperative BIS value between 40-60.The visual analogue scale (VAS) was recorded at 2h, 4h, 6h, 8h and 12h after operation.The postoperative analgesia of sufentanil and PCIA bolus times were recorded at 12 hours postoperatively.The incidence of complications such as postoperative sleepiness, skin pruritus, postoperative nausea and vomiting (PONV) and other anesthesia-related complications were recorded. Results The VAS scores of the patients in the P group [(1.41±0.29)points, (1.55±0.30)points] were significantly lower than those in the C group [(1.86±0.33)points, (1.95±0.41)points] both at static state and active state immediately out of the operation room (t=7.934, 6.099, all P<0.05). The dosage of sufentanil and the PCIA bolus times in the P group were significantly lower than those in the C group at 12 hours after operation (t=3.732, 4.205, all P<0.05). The incidence rates of lethargy, PONV and skin pruritus in the P group were significantly lower than those in the C group (χ2=8.107, 3.927, 4.227, all P<0.05). Conclusion In the patients of upper abdominal surgery, the analgesic effect of parecoxib sodium can significantly reduce the dosage of sufentanil and reduce the risk of postoperative complications at the same time, it is worthy of promotion in clinical use. Key words: Analgesia; Parecoxib sodium; Sufentanil

Effects of patient controlled analgesia with dexmedetomidine on recovery of intestinal function and inflammatory responses after radical colectomy in colon cancer patients

Objective To investigate effects of patient-controlled analgesia (PCA) with dexmedetomidine(Dex) on recovery of intestinal function and inflammatory response after radical colectomy in colon cancer patients. Methods Ninety colon cancer patients subjected to radical colectomy were enrolled in this study. They were randomly divided into 3 groups (n=30): patient-controlled analgesia with Dex+sufentanil+granisetron (group A), patient-controlled analgesia with sufentanil+granisetron (group B), bucinperazine (a painkiller) injection group (group C). For all groups, postoperative analgesia lasted for 3 days during which VAS scores (pain) and Ramsay scores (sedation) were calculated and venous plasma was extracted to examine the levels of TNF-α and IL-6, 12 h(T1), 24 h(T2) and 48 h(T3) after surgery. Anus exhaust time was also recorded. Results Compared with group C, both group A and B exhibited lower pain scores and higher sedation scores(P 0.05), group A showed higher sedation scores (P<0.05). Levels of TNF-α and IL-6 in venous plasma were lower in group A than those in Group B and C(P<0.05). Anus exhaust times in group B were much longer than those in group A and group C(P<0.05). Conclusions The combination of Dex and sufentanil for postoperative analgesia achieved optimal anti-nociceptive and sedative effects, but reduced inflammatory responses. Meanwhile, it accelerated the recovery of intestinal function after radical colectomy in colon cancer patients. Key words: Dexmedetomidine; Postoperative analgesia; Intestinal function; Inflammatory response

Clinical study of administration of dexmedetomidine combined sufentanil for postoperative analgesia in senile patients with total hip replacement

Objective Exploring the suitable protocol of dexmedetomidine(Dex) combined sufentanil intravenous infusion for controlled infusion analgesia(PCIA) in senile patients with total hip replacement. Methods The ninety elderly patients(65-89 y), ASAⅠ-Ⅲ, with total hip replacement were randomly divided into 3 groups(n=30). Group of sufentanil(group S): sufentanil 0.04 μg·kg-1·h-1 and tropisetron 5 mg, group of Dex 1(group D1): sufentanil 0.04 μg·kg-1·h-1, tropisetron 5 mg and Dex 0.02 μg·kg-1·h-1, group of Dex 2(group D2): sufentanil 0.04 μg·kg-1·h-1, tropisetron 5 mg and Dex 0.05 μg·kg-1·h-1, drugs in all groups were dissolved in sterile saline solution with total volume 150 ml. All patients′ anesthesia were performed by spinal block in L3-L4. Sufentanil with 5 μg intravenous injection was administrated in all of groups 10 min before the end of operation. The time of operation and anesthesia, amount of bleeding during operation, the incidence of adverse reactions(pruritus, nausea and emesis) for postoperative analgesia, the Bruggrmann comfort scale(BCS) scores, and the consumptions of sufentanil for 48 h analgesia were recorded. In addition, VAS scores and Ramsay scores were also recorded at postoperative 4, 8, 12, 24, 48 h. Results At the 8-48 h after operation, Ramsay scores of group S[(1.7±0.5),(1.6±0.6),(1.6±0.5),(1.8±0.5)] were lower than Ramsay scores of group D1[(2.2±0.6),(2.0±0.5),(2.2±0.5),(2.2±0.5)] and group D2[(2.3±0.5),(2.3±0.4),(2.4±0.5),(2.3±0.5)] (P<0.05). Ramsay scores of group D1 showed no significant difference with Ramsay scores of group D2. VAS scores of group D1[(0.7±0.8),(0.7±0.8)] were lower at the 12 h and 24 h after operation than VAS scores of group S[(1.3±1.1),(1.4±1.0)](P<0.05). But VAS cores of group D2[(0.8±0.6), (0.8±0.6), (0.6±0.7), (0.7±0.7)] were lower at 8-48 h than VAS scores of group S(P<0.05). In addition, BCS score for 48 h analgesia, group D1(3.2±0.7) was higher than score of group S(2.1±0.5)(P<0.01). BCS score of group D2(3.6±0.6) was significantly higher than scores of all of group S and group D1(P<0.05). The consumption amount of sufentanil for 48 h analgesia of group S[(2.02±0.10) μg/kg] was apparently much compared with group D1[(1.96±0.61) μg/kg] and group D2[(1.94±0.39) μg/kg](P<0.05). Consumption amount of sufentanil of group D2 had no significant difference with consumption amount of sufentanil of group D1. Conclusions The protocol of Dex 0.05 μg·kg-1·h-1 combined with sufentanil 0.04 μg·kg-1·h-1 intravenous infusion for postoperative analgesia in elderly patients with total hip replacement has better analgesic effect, greater patient satisfaction, and reduces the total consumption amount of sufentanil. It is a safe and feasible clinical application. Key words: Aged; Hip replacement; Postoperative analgesia; Dexmedetomidine; Sufentanil

Dexmedetomidine in combination with sufentanil for postoperative analgesia after partial laryngectomy

BackgroundDexmedetomidine as an adjunct with opioids has been confirmed to spare opioids usage and improve analgesia for postoperative pain treatment. Furthermore, dexmedetomidine can attenuate the airway reflex. The aim of this study is to assess the safety and efficacy of dexmedetomidine combined with sufentanil for postoperative analgesia after partial laryngectomy.MethodsA total of 60 adult male patients were recruited and randomly allocated to receive sufentanil 1.0 μg ml−1 (Group S) or sufentanil 1.0 μg ml−1 plus dexmedetomidine 4 μg ml−1 (Group SD) for postoperative analgesia. The IV patient controlled analgesia (PCA) device was programmed to deliver 1.5 ml per demand with a 10 min lockout interval and 1.5 ml per hour background infusion. Cumulative consumption of sufentanil and pain intensity during 24 hour (h) after surgery were recorded. Coughing episodes per day, sleep quality, hemodynamic and respiratory profiles were measured.ResultsCompared with Group S, patients in Group SD required less sufentanil during the 0–24 h postoperative period (p < 0.0001) and reported significant lower pain intensity from the second postoperative hour to the end of the study (P < 0.0001). Daily coughing episodes, sleep disturbance was lower and patients’ satisfaction was higher in Group SD (P < 0.05). Decrease in heart rate and mean blood pressure from baseline at 1 h, 2 h, 3 h, 12 h, and 24 h after operation were significantly greater in Group SD (P = 0.00). The incidence of PCA related adverse events were comparable between the two groups.ConclusionDexmedetomidine/sufentanil combination for postoperatjve analgesia in partial laryngectomized patients resulted in significant sufentanil sparing, better analgesia, reduced frequency coughing episodes, and better sleep quality.Trial registrationChinese Clinical Registry (ChiCTR): ChiCTR-TRC-14004618, date of registration: 08 May 2014.

The efficacy of dexmedetomidine combined with sufentanil for postoperative analgesia and the effect on immune function and pulmonary complications in patients undergoing operation of lung cancer

Objective To evaluate the efficacy of patient-controlled intravenous analgesia(PCIA) using dexmedetomidine (Dex) combined with sufentanil and the effect on postoperative immune function and pulmonary complications in patients undergoing operation of lung cancer. Methods One hundred and twenty patients with lung cancer were recruited in this study, and randomly divided into two groups for PCIA after thoracoscopic lobectomy, group A(Dex and sufentanil group, n=60) and group B (sufentanil group, n=60). VAS scores, observer's assessment of alertness/sedation(OAA/S) scores, and pulmonary complications were recorded after operation. And the number of natural killer (NK) cells, the level of interferon-γ (IFN-γ) or IL-4, and the ratio of T helper cells 1/T helper cells 2(Th1/Th2) were measured perioperation. Results There was no significant difference between the two groups in VAS, OAA/S scores and additional analgesics(P>0.05). The cases of pruritus, postoperative nausea and vomiting(PONV), and pulmonary complications in group B were 8, 16, 8 and 11, while they were 0, 2, 2 and 3 in group A, respectively(P 0.05), however, in group B, they all restored in 2 weeks after surgery(P>0.05). Conclusions Dex combined with sufentanil is efficient for PCIA in patients undergoing thoracoscopic lobectomy, it could decrease the incidence of pruritus, PONV and pulmonary complications, and promote the recovery of immune function. Key words: Dexmedetomidine; Lobectomy; Patient-controlled analgesia; Immunocompetence; Complication

Observation on Clinical Effects of Postoperative Analgesia with Sufentanil After Upper and Lower Abdominal Surgery: A Prospective Study

Post-operative analgesia is crucial to facilitate early ambulation, prevent complications, increase patient satisfaction while ensuring a faster recovery pace. Opioid analgesics have been recognized as the mainstay for treatment of acute pain in a majority of postoperative care units. Intravenous patient-controlled analgesia (IVPCA) with the opioids drugs sufentanil and fentanyl has proven to be effective when used in the immediate postoperative period. The aim of the study was to determine the efficacy and safety of sufentanil for postoperative analgesia based on the same principle, and, fentanyl citrate was chosen as a control drug for upper and lower abdominal operations under general anesthesia. Methodology; It was a prospective clinical study carried out at Union hospital, from December 2014 to March 2015. 240 patients were scheduled for upper and lower abdominal surgery requiring general anesthesia. They were divided into four groups: test group (A) and control group (B); (C) and (D), and are given fentanyl and sufentanil by IVPCA for postoperative analgesia relief following surgery. Pain was assessed by the visual analogue Scale. The determined pain relief; pulse rate, BP, ECG, sedation score, SPO2, pruritus score, nausea score and vomiting score were all recorded for each patient. Results The pressing times values show that fentanyl (A) and high dose sufentanil (C, D) both provided a satisfactory level of analgesia. Moreover, VAS scores of the patients on high dose sufentanil (C, D) were lower, implying superior analgesic effects at these doses. However, low dose sufentanil (B) may only provide limited and inadequate analgesia. The degree of pruritus was less marked in patients on sufentanil than those on fentanyl as demonstrated by the lower Pruritus scores in sufentanil groups (B, C, D). Low dose sufentanil and fentanyl have shown to have similar extent of side effects overall. Conclusion It was found that sufentanil had superior analgesic effect to that of fentanyl in patients who had undergone open abdominal surgery. The extent of the occurrence of adverse reactions to light in the low-dose sufentanil group (B) is less than that in the high-dose groups (C, D), the concentration of persistent postoperative analgesia sufentanil should reach 0.02μg / (kg ml), and the flow rate maintained at 2ml / h.

Evaluation of intraperitoneal levobupivacaine with and without sufentanil for postoperative analgesia after laparoscopic cholecystectomy

Background and objectives Postoperative pain after laparoscopic cholecystectomy (LC) is unpredictable, which explains the need for systematic prevention of pain before the patient wakes up from anesthesia. The study was conducted to evaluate the effect of intraperitoneal levobupivacaine with or without sufentanil for postoperative analgesia after LC. Patients and methods Ninety patients who underwent elective LC completed the study. Group C ( n =29) received 50 ml of intraperitoneal normal saline, group L ( n =31) received 50 ml of intraperitoneal levobupivacaine 0.25%, and group LS ( n =30) received 50 ml of intraperitoneal levobupivacaine 0.25% plus 20 μg sufentanil. Visual analog score was recorded immediately postoperatively, and at 4, 8, and 12 h postoperatively. In addition, time to first rescue analgesia (diclofenac), total diclofenac consumption in 12 h, and complications (pruritus, emesis, shoulder pain, bradycardia, and hypotension) were recorded. Results Visual analog score until 8 h postoperatively was significantly higher in group C compared with groups L and LS. However, the difference was nonsignificant between groups L and LS, except at 8 and 12 h postoperatively. Time to first rescue analgesia was significantly longer in group LS (134.16±36.5) compared with group C (11.96±5.92) and group L (114.83±35.49) ( P Conclusion Intraperitoneal instillation of levobupivacaine with sufentanil reduces not only the intensity of postoperative pain but also the total rescue analgesic dose consumption after LC.

Application of intravenous flurbiprofen axeyil injection combined with sufentanil for postoperative analgesia of ovarian cancer radical operation

Objective To evaluate the efficacy and safety of flurbiprofen axeyil injection combined with sufentanil for postoperative patient undergoing ovarian cancer radical operation.Methods 60 postoperative patients undergoing radical ovarian cancer surgery were randomly divided into three groups with 20 cases in each group, including Sufentanil 150 μg (group S) ,Flurbiprofen Axeyil injection 200 mg (group F) ,Flurbiprofen Axeyil injection 100 mg plus Sufentanil 100 μg (group FS).The drugs in each group were added with Azasetron 10 mg and diluted to 100 ml, then infused by a pump in a rate of 2 ml/h.The visual analogue scale (VAS) and Ramesays scores were used to evaluate the analgesic effect at 0.5,2,4,8,12,24 and 48 h after surgery.The incidence of side effects was recorded.Results All the patients showed good pain relief with PCIA.The VAS of group F(3.3 +0.8) at 2 h after operation was slightly higher than that of group S (2.6 + 1.0) and SF (2.8 + 1.1) (P ＜ 0.05), which became similar 4 h later (P ＞0.05).In groups F (2.4 +0.8,2.3 +0.6) and FS(2.9 +0.8,2.6 ±0.4), the average Ramsay score was slightly lower than that in group S(3.8 +0.9,3.6 +0.5) (P ＜0.05).But the differences were not significant within 8 h after operation (P ＞ 0.05).The accidence rates of nausea, vomiting, itching, somnolence of group S(20％ ,15％ ,20％) were significantly higher than those in group F (5％ ,0,5％)and FS(5％,5％ ,5％) (P ＜0.05).No respiratory depression or abnormal bleeding occurred in three groups during the period of postoperative 48 hour.The amount of hydrothorax had no difference between 3 groups (P ＜0.05).Conclusions Intravenous postoperative analgesia with Flurbiprofen Axeyil injection combined with Sufentanil had a better analgesic effect than Sufentanil or Flurbiprofen Axeyil used alone, and it could significantly reduce the dose requirement of Sufentanil as well as its associated side effects. Key words: Flurbiprofen/AD; Sufentanil/AD; Ovarian neoplasms/SU ; Analgesia, patient-controlled

Nefopam combined with sufentanil for postoperative analgesia in patients with mixed hemorrhoids

Nefopam combined with sufentanil for postoperative analgesia in patients with mixed hemorrhoids

Epidural combination of ropivacaine with sufentanil for postoperative analgesia after total knee replacement: a pilot study

Epidural combination of ropivacaine with sufentanil for postoperative analgesia after total knee replacement: a pilot study

Efficacy of ropivacaine compared with ropivacaine plus sufentanil for postoperative analgesia after major knee surgery

This study compared the analgesic efficacy of an epidural infusion of ropivacaine and ropivacaine with sufentanil following major knee surgery. In a double-blind clinical trial, 115 adult patients received either epidural ropivacaine (R group, 2 mg.ml(-1)), or ropivacaine (2 mg.ml(-1)) with sufentanil (RS group, 1 microg.ml(-1)), using a patient-controlled epidural analgesia technique. Pain scores (visual analogue scale, VAS, and the simple descriptive scale, SDS), side-effects, motor block and treatment quality were recorded at 6, 12 and 24 h after the insertion of the epidural catheter. In the RS group, analgesic efficacy was significantly greater than in the R group between 12 and 24 h following insertion of the epidural catheter (VAS: 92.9% vs. 72.9%, p = 0.009). There was no significant difference during the other periods. Pruritus, nausea and vomiting were significantly more frequent in the RS group. Good postoperative analgesia was obtained with an epidural infusion of ropivacaine (2 mg.ml(-1)). When this local anaesthetic was administered with sufentanil, there was an improvement in the analgesic effect but a significant increase in the number of patients who reported adverse effects. The differences were more pronounced 12 h after the beginning of the analgesic schedule. This study failed to demonstrate any worthwhile clinical benefit from the addition of sufentanil.