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Spinal sufentanil superior to fentanyl for postcaesarean analgesia
ESRA Academy. Pitkanen M. Mar 7, 2017; 170351
Mikko Pitkanen
Mikko Pitkanen
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This is another study comparing the effects of intrathecal fentanyl and sufentanil in anaesthesia and analgesia for Caesarean section. There were three groups (fentanyl 25 μg, sufentanil 2.5 and 5 μg). The sample size (3 x 60 patients) was large enough to provide statistical significance. The results are in agreement with earlier results (1,2) (references 6 and 8 in the manuscript) where intrathecal sufentanil (2.5 or 5 μg) produced longer duration of analgesia after Caesarean section compared to intrathecal fentanyl (5–10 μg). In the present study the same result was obtained despite the use of a higher dose of fentanyl.
The duration of effective analgesia (time to start of patient-controlled intravenous analgesia, PCIA) was 30–40 minutes longer in the sufentanil groups. The difference between the groups was greater if the time to VAS > 4 was compared (300, 420 and 600 minutes).
The patients in sufentanil groups had a better pain relief but the frequency of side-effects (pruritus, nausea and hypotension) was not increased.
The older studies compared sufentanil, fentanyl and placebo, but here no placebo group was used. The present study would have been more valuable if a placebo group had been included. Interestingly, the authors report three errors of programming of PCIA morphine pump 3/180 (1.7%) and do not find this a problem. In my opinion, PCIA error in one patient out of 60 should be considered seriously.
In conclusion, this study supports the earlier studies where intrathecal sufentanil is superior to intrathecal fentanyl in postoperative pain relief after Caesarean section.

1. Dahlgren G, Hultstrand C, Jakobsson J, Norman M, Eriksson EW, Martin H. Intrathecal sufentanil, fentanyl, or placebo added to bupivacaine for cesarean section. Anesth Analg 1997; 85: 1288–93
2. Meininger D, Byhahn C, Kessler P, Nordmeyer J, Alparslan Y, Hall BA, Bremerich DH. Intrathecal fentanyl, sufentanil, or placebo combined with hyperbaric mepivacaine 2% for parturients undergoing elective cesarean delivery. Anesth Analg 2003; 96: 852–8

BACKGROUND:

Fentanyl and sufentanil are the most commonly administered intrathecal lipophilic opioids worldwide, although their relative efficacy when given by this route is not well characterised. The primary endpoint of this prospective, randomised, double-blind study was to compare effective analgesia duration of intrathecal administered fentanyl 25 μg and sufentanil 2.5 or 5 μg, Second endpoints were to compare post-operative morphine consumption and incidence of side effects between these opioids dosages.

METHODS:

After IRB approval, 180 full-term parturients undergoing elective Caesarean section were randomly allocated into three groups, according to the opioid added to 10 mg intrathecal hyperbaric bupivacaine: fentanyl 25 μg, sufentanil 2.5 μg or sufentanil 5 μg. Total effective analgesia was defined as time from spinal injection (T0) to first IV morphine requirement (T1) administered with a patient controlled intravenous pump. Statistical data analysis included non-parametric tests and chi-squared. A P value < 0.05 was considered statistically significant. Data are presented as median [interquartile ranges 25-75].

RESULTS:

Duration of analgesia was significantly longer with sufentanil 2.5 μg (214 min [189-251]) and 5 μg (236 min [190-372]) compared to fentanyl 25 μg (187 min [151-230]) (P < 0.01). Morphine consumption at T1 + 4 h was lower in the sufentanil groups (6 mg [3-9] and 6 mg [2-10]) than in the fentanyl group (9 mg [5-13]) (P < 0.01). Incidence of adverse effects was not different between groups.

CONCLUSION:

In the conditions of our study, sufentanil 5 μg was the opioid of choice, associated with the best quality of anaesthesia without increased incidence of side effects.

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