BACKGROUND: The use of lipid soluble opioids such as fentanyl, alfentanil and sufentanil are recently on the increase for patient-controlled epidural analgesia (PCEA). In this study, the effects and adequate dose of sufentanil in arthroplasty were investigated. METHODS: Eighty patients scheduled for arthroplasty were enrolled for the study. Seventy-one patients (ASA physical status I-III) were randomly allocated into four groups. All groups received 0.1% ropivacaine through PCEA and each group received either fentanyl (group F: fentanyl 4 microg/ml) or sufentanil (group S1: sufentanil 0.5 microg/ml, group S2: sufentanil 0.75 microg/ml, and group S3: sufentanil 1.0 microg/ml). Postoperative pain scores were evaluated using VAS (visual analog scale, 0-10) and side effects such as hypotension, nausea/vomiting, pruritus and the degree of satisfaction were evaluated at 1, 6, 12, 24, 48 hours after surgery. RESULTS: Postoperative pain score (VAS) decreased gradually and the highest VAS score was recorded at 1 hour postoperative for all four groups. There were no differences in the degree of satisfaction and postoperative pain score between all groups. The incidence of pruritus was significantly lower in group S1 than in groups S2 and S3. CONCLUSIONS: The incidence of side effects were significantly lower in group S1 (0.1% ropivacaine plus sufentanil 0.5 microg/ml). Therefore, 0.5 microg/ml of sufentanil through PCEA is the recommended dose for postoperative pain control in arthroplasty.
Alfentanil ; Amides ; Analgesia, Epidural ; Analgesics, Opioid ; Arthroplasty ; Fentanyl ; Humans ; Hypotension ; Incidence ; Pain, Postoperative ; Pruritus ; Sufentanil

BACKGROUND: Spinal opioid administration is an excellent option to separate the desirable analgesic effects of opioids from their expected dose-limiting side effects to improve postoperative analgesia. Therefore, physicians must better identify either specific opioids or adequate doses and routes of administration that result in a mainly spinal site of action rather than a cerebral analgesic one. METHODS: The purpose of this topical review is to describe current available clinical evidence to determine what opioids reach high enough concentrations to produce spinally selective analgesia when given by epidural or intrathecal routes and also to make recommendations regarding their rational and safety use for the best management of postoperative pain. To this end, a search of Medline/Embase was conducted to identify all articles published up to December 2013 on this topic. RESULTS: Recent advances in spinal opioid bioavailability, based on both animals and humans trials support the theory that spinal opioid bioavailability is inversely proportional to the drug lipid solubility, which is higher in hydrophilic opioids like morphine, diamorphine and hydromorphone than lipophilic ones like alfentanil, fentanyl and sufentanil. CONCLUSIONS: Results obtained from meta-analyses of RTCs is considered to be the 'highest' level and support their use. However, it's a fact that meta-analyses based on studies about treatment of postoperative pain should explore clinical surgery heterogeneity to improve patient's outcome. This observation forces physicians to use of a specific procedure surgical-based practical guideline. A vigilance protocol is also needed to achieve a good postoperative analgesia in terms of efficacy and security.
Alfentanil ; Analgesia ; Analgesics, Opioid ; Animals ; Biological Availability ; Fentanyl ; Heroin ; Humans ; Hydromorphone ; Morphine ; Pain, Postoperative* ; Population Characteristics ; Solubility ; Sufentanil

BACKGROUND: Additive opioids in spinal anesthesia of cesarean section decrease the dose of local anesthetics and increase the quality of anesthesia. There were comparative studies about morphine, fentanyl, and sufentanil as an additive opioid in spinal anesthesia of cesarean section, but few studies about alfentanil. In this study we compared the effect of alfentanil with fentanyl as an additive opioid in spinal anesthesia for cesarean section. METHODS: Sixty nine pregnant women, American Society of Anesthesiologist (ASA) I-II, who were scheduled for elective cesarean section under spinal anesthesia, were randomly allocated into two groups: group F received 8 mg (1.6 ml) of bupivacaine and 15microg of fentanyl (0.3 ml) intrathecally, and group A received 8 mg of bupivacaine and 150microg of alfentanil (0.3 ml). Sensory block defined by pin-prick, intraoperative patient satisfaction for analgesia by visual analogue scale (VAS), blood pressure, and side effects were assessed. Apgar score and umbilical arterial blood gas analysis were also assessed. RESULTS: The analgesic effect of alfentanil was as good as fentanyl and VAS for satisfaction was 97.1 +/- 7.6 and 96.5 +/- 8.0 each. Time to achieve anesthetic level of T6 (6.2 vs 6.7 min), maximal block level (T3.7 vs T3.8), lowest blood pressure during the operation (60.0 vs 61.0 mmHg), duration of analgesia (77.2 vs 70.0 min), and fetal assessment were not different from those of group F, either. The incidence of nausea during operation was 48.6% in group F and 26.4% in group A (P = 0.14). CONCLUSIONS: The addition of alfentanil is comparable to fentanyl in analgesia, maternal and fetal effects in spinal anesthesia for cesarean section.
Alfentanil ; Analgesia ; Analgesics, Opioid ; Anesthesia ; Anesthesia, Spinal ; Anesthetics, Local ; Apgar Score ; Blood Gas Analysis ; Blood Pressure ; Bupivacaine ; Cesarean Section ; Female ; Fentanyl ; Humans ; Incidence ; Morphine ; Nausea ; Patient Satisfaction ; Pregnancy ; Pregnant Women ; Sufentanil

No abstract available.
Fentanyl ; Syringes

OBJECTIVE: Postoperative pain is one of the major complaints of patients after lumbar fusion surgery. The authors evaluated the effects of intravenous patient controlled analgesia (IV-PCA) using fentanyl or sufentanil on postoperative pain management and pain-related complications. METHODS: Forty-two patients that had undergone surgery with lumbar instrumentation and fusion at single or double levels constituted the study cohort. Patients were equally and randomly allocated to a sufentanil group (group S) or a fentanyl group (group F) for patient controlled analgesia (PCA). Group S received sufentanil at a dose of 4 μg/kg IV-PCA and group F received fentanyl 24 μg/kg IV-PCA. A numeric rating scale (NRS) of postoperative pain was applied before surgery, and immediately and at 1, 6, and 24 hours (hrs) after surgery. Oswestry disability index (ODI) scores were obtained before surgery and one month after surgery. Opioid-related side effects were also evaluated. RESULTS: No significant intergroup difference was observed in NRS or ODI scores at any of the above-mentioned time points. Side effects were more frequent in group F. More specifically, nausea, vomiting rates were significantly higher (p=0.04), but pruritus, hypotension, and headache rates were non-significantly different in the two groups. CONCLUSION: Sufentanil displayed no analgesic advantage over fentanyl postoperatively. However, sufentanil should be considerable for patients at high risk of GI issues, because it had lower postoperative nausea and vomiting rates than fentanyl.
Analgesia, Patient-Controlled* ; Cohort Studies ; Fentanyl* ; Headache ; Humans ; Hypotension ; Nausea ; Pain, Postoperative ; Postoperative Nausea and Vomiting ; Pruritus ; Sufentanil* ; Vomiting

We have experienced early extubation after 20 consecutive open heart surgeries for congenital heart disease between May 19 th and May 30 th this year. Eighteen of those 20 had the tracheal tube removed in the operating room immediately after operation. The reanlts were good and satisfactory. Two required postoperative ventilatory support for several hours at RICU. Sufentanil (Sufenta) 10-15 ug/kg was used intravenously as a major narcotic anesthetic for 18 podiatric patients and Fentanyl 50 ug/kg used for 2 adult Patients. The advantages of early extubation are as follows ; It is more physiologic, more comfortable, psychologically leas anxiety provoking for the patients and has less chance of pulmonary infection and less chance of ventilator mishaps arid it also shortens RICU stay and hospitalization. It is concluded that early extubation after open heart surgery for congenital heart disease has minimal risk and definite advantages in carefully selected patients.
Adult ; Anxiety ; Fentanyl ; Heart Defects, Congenital ; Heart Diseases* ; Heart* ; Hospitalization ; Humans ; Operating Rooms ; Sufentanil ; Thoracic Surgery* ; Ventilators, Mechanical

Adolescent ; Adult ; Anesthesia, Intravenous ; Anesthetics, Intravenous ; Cardiopulmonary Bypass ; Female ; Fentanyl ; Heart Valve Prosthesis Implantation ; Humans ; Male ; Middle Aged ; Sufentanil

Objective To establish an ultra-high performance liquid chromatography-tandem mass spectrometry （UPLC-MS/MS） rapid determination method for simultaneous analysis of 20 fentanyl-related substances in blood. Methods With fentanyl-D₅ as an internal standard, the blood was extracted by liquid-liquid extraction （LLE）, then separated with an ACQUITY UPLC HSS T₃ chromatographic column, and finally 20 fentanyl-related substances were simultaneously analyzed with multiple reaction monitoring （MRM） mode. Results The limits of detection （LOD） of all compounds were 0.02-0.03 ng/mL, and the limits of quantitation （LOQ） were 0.05-0.2 ng/mL. Within the mass concentration range of 0.05-40 ng/mL, 20 fentanyl-related substances had a good linear relationship, and correlation coefficients were larger than 0.99. The accuracy of the method was 87.69%-114.68% and the extraction recovery rate was 85.35%-101.80%, and no significant matrix effect was observed. The established method was successfully applied to the detection of sufentanil in rat blood after sufentanil was injected. Sufentanil could still be detected in blood of rats 10 h after sufentanil injection. Conclusion The established method has the advantages of simple pretreatment, high sensitivity and good selectivity, and can be used for the determination of fentanyl-related substances in forensic toxicology analysis.
Animals ; Chromatography, High Pressure Liquid ; Fentanyl/blood* ; Forensic Toxicology ; Rats ; Reproducibility of Results ; Sufentanil/blood* ; Tandem Mass Spectrometry

BACKGREOUND: The hemodynamic responses to laryngoscopy and endotracheal intubation, tachycardia and arterial hypertension, are well known and should be minimized. The purpose of this study is comparison of effects of low-dose sufentanil and fentanyl on the changes of blood pressure and heart rate due to laryngoscopy and endotracheal intubation. METHODS: The cardiovascular responses were measured and compared in 60 patients, between 20~65 years old, ASA class I or II, undergoing elective operation pretreated with normal saline (n=20, control group), fentanyl 3 microgram/kg (n=20, fentanyl group), and sufentanil 0.6 microgram/kg (n=20, sufentanil group), respectively. Anesthesia was induced intravenously with pentothal sodium 4~5 mg/kg and endotracheal intubation was conducted after injection of succinylcholine 1 mg/kg. The changes of systolic arterial pressure, mean arterial pressure, diastolic arterial pressure, heart rate, and SpO2 (saturation of arterial oxygen) were measured at postsedation with pentothal sodium, 30 seconds, 1 minute, and 3 minutes following intubation. The variables of each group were compared with preinduction baseline values and fentanyl and sufentanil groups were compared with control group. Data were analyzed for statistical significance using repeated measures of ANOVA (analysis of variance). P<0.05 was considered statistically significant. RESULTS: The systolic and mean arterial pressures at 30 seconds and 1 minute and diastolic arterial pressure at 30 seconds after laryngoscopy and intubation in sufentanil group were significantly lower than values of control group (p<0.01). The heart rates at 30 seconds and 1 minute were significantly attenuated compared with control group (p<0.05). The blood pressures and heart rates of fentanyl group at 30 seconds after intubation were significantly attenuated compared with control group (p<0.05). CONCLUSIONS: The results suggest that pretreatment of fentanyl 3 microgram/kg and sufentanil 0.6 microgram/kg is effective to prevent the elevation of blood pressures and heart rates, and sufentanil 0.6 microgram/kg is more effective than fentanyl 3 microgram/kg to attenuate the hemodynamic changes due to laryngoscopy and intubation.
Anesthesia* ; Arterial Pressure ; Blood Pressure* ; Fentanyl* ; Heart Rate* ; Heart* ; Hemodynamics ; Humans ; Hypertension ; Intubation ; Intubation, Intratracheal ; Laryngoscopy ; Sodium ; Succinylcholine ; Sufentanil* ; Tachycardia ; Thiopental

BACKGROUND: Laryngoscopy and tracheal intubation usually induce tachycardia and hypertension. Various drugs including esmolol and fentanyl have been employed to reduce the cardiovascular response accompanying laryngoscopy and intubation. The purpose of this study is to assess the efficacy of low dose sufentanil with esmolol in reducing hypertension and tachycardia induced by endotracheal intubation. METHODS: Forty surgical patients from Kosin medical hospital were randomly assigned to receive either normal saline (n = 20, control group) or sufentanil (0.3 microgram/kg) with esmolol (1 mg/kg) (n = 20, S & E group) before anesthetic induction. Anesthesia was induced intravenously with pentothal sodium 4 mg/kg followed by endotracheal intubation after succinylcholine 1 mg/kg. Changes in systolic blood pressure, mean arterial blood pressure, diastolic blood pressure, heart rate, and SpO2 (arterial oxygen saturation by pulse oximeter) were measured at 30 seconds, 1 minute, 2 minutes, 3 minutes, 4 minutes and 5 minutes following intubation. The values of each group were compared with preinduction baseline values, and the S&E group was compared with the control group. Data were analyzed for statistical significance using repeated measures of ANOVA and chi-square test. RESULTS: In the S&E group, the systolic and mean arterial pressures at 30 seconds and 1 minute, and diastolic blood pressure at 30 seconds after intubation were significantly lower than the values of the control group (P < 0.01). The heart rates at 30 seconds, 1 minute were significantly lower compared to the control group (P < 0.01 and P < 0.05, respectively). CONCLUSIONS: The results suggest that pretreatment of low dose sufentanil with esmolol is effective to reduce the elevation of blood pressure and heart rate due to laryngoscopy and intubation.
Anesthesia ; Arterial Pressure ; Blood Pressure* ; Fentanyl ; Heart Rate* ; Heart* ; Humans ; Hypertension ; Intubation ; Intubation, Intratracheal* ; Laryngoscopy ; Oxygen ; Sodium ; Succinylcholine ; Sufentanil* ; Tachycardia ; Thiopental