Opioid-induced rigidity is a potentially life-threatening complication that can occur after treatment with large doses of opioids, but with early recognition it can be treated effectively with naloxone or with muscle relaxants. Regarding its onset time, there have been few case reports that have described delayed manifestations of opioid-induced rigidity. The mechanism of this complication is not well understood. In this report we describe a case of incidental overdose injection of sufentanil and subsequently review the confusing clinical features that require immediate diffenrentiation and the possible mechanim of this complication.
Analgesics, Opioid ; Muscle Rigidity ; Muscles ; Naloxone ; Sufentanil

BACKGROUND: Continuous epidural analgesia with an opioid-local anesthetic combination is an effective strategy for postoperative pain relief after abdominal surgery. Levobupivacaine, the pure S (-) enantiomer of racemic bupivacaine, is similar to its native agent for anesthetic efficacy but has less cardiotoxic and neurotoxic potential than the bupivacaine. We compared the efficacy and safety of 0.1% levobupivacaine with sufentanil or 0.2% levobupivacaine with the same dose of suentanil for patient-controlled epidural analgesia after major abdominal surgery. METHODS: Forty patients scheduled for major abdominal surgery under general anesthesia were randomized to receive either 0.1% levobupivacaine with sufentanil 0.75microgram/ml (n = 20) or 0.2% levobupivacaine with sufentanil 0.75microgram/ml (n = 20) for postoperative epidural analgesia using a patient-controlled analgesia pump at a rate of 3 ml/h and bolus dose of 2 ml on demand. Visual analogue scale (VAS) pain scores at rest, on coughing, during mobilization from the supine to the sitting position and on ambulation were assessed during 48 hours following the surgery. In addition, degree of motor block and mobilization, additional analgesic requirements and adverse effects were assessed. RESULTS: There were no significant differences in VAS pain scores at rest, on coughing, during mobilization from the supine to the sitting position and on ambulation. There were no significant differences in mean volume of local anesthetic consumption, additional analgesic requirements, degree of motor block and mobilization and the incidence of adverse effects. CONCLUSIONS: 0.1% levobupivacaine with sufentanil provided comparable postoperative epidural analgesia and incidences of adverse effects to 0.2% levobupivacaine with the same dose of suentanil in patients undergoing major abdominal surgery.
Analgesia, Epidural ; Analgesia, Patient-Controlled ; Anesthesia, General ; Bupivacaine ; Cough ; Humans ; Incidence ; Pain, Postoperative ; Sufentanil ; Walking

BACKGROUND: Laryngoscopy and tracheal intubation often cause hemodynamic changes such as hypertension and tachycardia. This study was carried out to determine the optimal dose of sufentanil for attenuating the hemodynamic changes that occur during the induction of anesthesia with propofol. METHODS: The authors examined 100 ASA class 1-2 patients, who were scheduled for elective surgery anddivided randomly into 4 groups. Anesthesia was induced with propofol (5.0microg/kg target controlled infusion). Three minutes later, rocuronium 1.2 mg/kg was administered. Group 1 (CON group) received no sufentanil, and groups 2, 3 and 4 (SO3, SO5, SO7 groups) received 0.3, 0.5, 0.7 microg/kg, sufentanil, respectively. The hemodynamic changes and BIS were measured at preinduction, 1 and 3 minutes after propofol infusion, and 1 and 3 minutes after sufentanil infusion, intubation, and post-intubation period for 10 minutes. RESULTS: In the SO3, SO5, SO7 groups, the systolic and diastolic and mean arterial pressure did notincrease compared with that at preinduction. However, in the SO7 group, the systolic and diastolic and mean arterial pressure decreased significantly 1 minute after intubation. In the SO3 group, the heart rate increased significantly after intubation compared with preinduction. On the other hand, the heart rate did not increase after intubation in the SO5 and SO7 groups. CONCLUSIONS: When anesthesia is induced with propofol TCI (5.0 microg/ml, the authors suggest that the recommended dosage of sufentanil for attenuating the hemodynamic changes accompanying a laryngoscopy and tracheal intubation be approximately 0.5microg/kg.
Anesthesia ; Arterial Pressure ; Hand ; Heart Rate ; Hemodynamics* ; Humans ; Hypertension ; Intubation* ; Intubation, Intratracheal ; Laryngoscopy ; Propofol ; Sufentanil* ; Tachycardia

BACKGROUND: Thoracotomy is considered one of the most painful surgical procedures. Thus optimal pain control is essential in the postoperative care of thoracotomy patients. In this randomized double-blinded study, we sought to determine an optimal dose-combination of sufentanil and ropivacaine 0.2% for postoperative epidural analgesia. METHODS: Forty-five of fifty-two patients that underwent thoracotomy were assigned to three groups to receive continuous high thoracic epidural analgesia with ropivacaine 0.2% + sufentanil 0.5microgram/ml (group I), ropivacaine 0.2% + sufentanil 0.75microgram/ml (group II), or ropivacaine 0.2% + sufentanil 1.0microgram/ml (group III). Upon completion of surgery, a thoracic epidural catheter was inserted at the T1-3 level, and moved downward by 5-7 cm. Epidural continuous infusion was administered at 5 ml/hr. Resting VAS (visual analogue scale), dynamic VAS, forced vital capacity, and side effects were recorded at three times: immediate after extubation; 12 hours after arrival at the ICU; and 24 hours after arrival at the ICU. RESULTS: Resting VAS was significantly lower in group III immediately after extubation (P < 0.05) and dynamic VAS was significantly lower in group III immediately after extubation, and 12 hours after arriving at the ICU (P < 0.05) than in the other two groups. The differences in ketorolac dosing number, sedation scores, respiratory depression, pruritus, nausea/vomiting, and motor block were not significant between the three groups. CONCLUSIONS: We conclude that the combination of ropivacaine 0.2% and sufentanil 1.0microgram/ml provides effective analgesia for post-thoracotomy pain with fewer side effects than the other two combinations tested.
Analgesia ; Analgesia, Epidural ; Catheters ; Humans ; Ketorolac ; Postoperative Care ; Pruritus ; Respiratory Insufficiency ; Sufentanil ; Thoracotomy* ; Vital Capacity

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: Early pain control after gastrectomy is essential to minimize complication. We have compared the analgesic efficacy and side effects of sufentanil versus morphine for postoperative epidural analgesia. And we investigated the optimal dosage of sufentanil. METHODS: Sixty of seventy-five patients underwent gastrectomy were randomly allocated into three groups to receive ropivacaine 0.15% + sufentanil 0.5microgram/hour (group S1), or ropivacaine 0.15% + sufentanil 1.0microgram/hour (group S2) or ropivacaine 0.15% + morphine 32microgram/hour (group M). Before surgery, an epidural catheter was inserted at T 7-9 level and sufentanil 20microgram in group S1 and S2 or morphine 2 mg in group M were injected via the epidural catheter. After completion of surgery, continuous epidural infusion was started using PCEA device. Basal infusion rate, lock out time, bolus dose were 4 ml/hour, 20 minutes and 4 ml, respectively. Resting VAS, coughing VAS and side effects were recorded : immediate after awakening, 6, 12, 24, 48 hours after surgery. Forced vital capacity was assessed before and at 6, 24, 48 hours after surgery. RESULTS: There were no significant differences in resting VAS, coughing VAS and FVC among three groups. The number of side effects, especially pruritus and sedation were significantly more in group M than group S1 and S2 (P <0.05). No difference was seen between group S1 and S2. CONCLUSION: Thoracic epidural application of sufentanil combined with ropivacaine provides effective analgesia after gastrectomy, which is comparable to the analgesia with ropivacaine plus morphine and it provides less side effects especially pruritus and sedation. In addition, the optimal dosage of sufentanil was 2microgram/hour.
Analgesia ; Analgesia, Epidural* ; Catheters ; Cough ; Gastrectomy* ; Humans ; Morphine* ; Pruritus ; Sufentanil* ; Vital Capacity

BACKGROUND: Sufentanil has been shown to act synergistically when combined with propofol, or when combined with potent inhalation anesthetics. The aiml of this study was to determine the dosing rate and target plasma concentration of propofol in the presence of low concentrations and to determine the impact of sufentanil infusion. METHODS: Sixty patients undergoing a plastic surgery and urologic surgery were anesthetized with nitrous oxide, and given a target-controlled infusion (TCI) of sufentanil [target plasma concentrations of 0 (group 1) and 0.05 ng/ml (group 2)], and propofol at rates varying according to the bispectal index (BIS). The mean target concentration (Tc) and infusion rate of propofol according to the changes in the sufentanil concentrations were determined. The recovery time (from stopping the infusion to eye opening) and side effects were compared. RESULTS: The induction time and recovery time were shorter in group 2 than in group 1 (P < 0.05). The infusion rate and mean target concentration of propofol were significantly lower in group 2 (148.8 +/- 25.2 microgram/kg/min, 4.1 +/- 0.8 microgram/ml) than in group 1 (161.7 +/- 26.9 microgram/kg/min, 4.7 +/- 0.5 microgram/ml) (P < 0.01). There were a similar number of side effects in the two groups. CONCLUSIONS: The blood propofol and plasma sufentanil concentrations in the plastic surgery and urologic surgery patients, with respect to satisfactory intraoperative anesthetic conditions and speed of recovery, were 4.1 +/- 0.8 microgram/ml and 0.05 ng/ml.
Anesthesia, General* ; Anesthetics, Inhalation ; Humans ; Nitrous Oxide ; Plasma ; Propofol* ; Sufentanil* ; Surgery, Plastic

BACKGROUND: The synthetic narcotic sufentanil has been used in clinical practice for anesthetic induction and maintenance. But there is little information concerning its direct effects on heart. The purpose of this study is to evaluate the direct effects of sufentanil on contracture of ventricular myocardium. METHODS: Isometric contraction of isolated right ventricular papillary muscle of rabbit was measured under 0.2 Hz electrical stimulation in Krebs solution. Peak developed force(F), maximum rate of rise of developed force(+dF/dt(max)), maximum rate of fall of developed force(-dF/dt(max)) were analyzed. RESULTS: There were no statistically significant differences in frequency of isometric contraction from the 100% baseline value in time-matched control group. Sufentanil, in concentration of 0.01-0.1 mM, increased F, and -dF/dt(max) was decreased especially in concentration of 0.1 mM but not +dF/dt(max) Fo +dF/dt(max) and -dF/dt(max) were statistically different from time-matched control group in concentration of 0.1 mM. CONCLUSIONS: We conclude that sufentanil has mild contracture effect on ventricular muscle of rabbit directly.
Analgesics ; Contracture ; Electric Stimulation ; Heart ; Isometric Contraction ; Myocardium ; Papillary Muscles ; Rabbits* ; Sufentanil*

Aged ; Humans ; Intensive Care Units ; Male ; Muscle Rigidity ; chemically induced ; diagnosis ; Sufentanil ; adverse effects

Patient controlled epidural anlagesia is a commonly used method for postoperative pain management. The purpose of this study is to determine the optimal concentration of sufentanil for patient controlled epidural analgesia. Twenty eight patients who underwent elective gastrectomy were enrolled in this study. Patients were randomly assigned to one of two groups of 0.5 µg/mL (group S1) and 0.7 µg/mL (group S2). At 2 hours, 1 day, 2 days and 3 days after surgery, the patient's pain degree was checked by numerical rating scale (NRS) and the presence of side effects was assessed. In both groups, the NRS decreased linearly with time. The NRS of the two groups differed but the trend of decrease did not show significant difference. The overall incidence of side effects was 45.5% (group S1) and 58.8% (group S2), respectively. Patient controlled epidural analgesia using sufentanil was effective in controlling postoperative pain, which was found to decrease with time. When comparing the two concentrations used in this study, 0.5 µg/mL had a lower incidence of side effects than the concentration of 0.7 µg/mL, and the pain relief trends of the two concentrations were similar.
Analgesia, Epidural* ; Analgesia, Patient-Controlled ; Gastrectomy* ; Humans ; Incidence ; Methods ; Pain, Postoperative ; Sufentanil*