[Brachial plexus block: effect of the addition of sufentanil to local anesthetic mixture on postoperative analgesia duration]. / Bloc du plexus brachial: effect de l'addition de sufentanil au mélange d'anesthésiques locaux sur la durée de l'analgésie postopératoire.

OBJECTIVES: To compare the quality and the duration of analgesia produced by a supraclavicular brachial plexus blockade obtained with a mixture of lidocaine and bupivacaine when supplemented or not with sufentanil. STUDY DESIGN: Prospective, randomized, double-blind study. PATIENTS: The study included 40 patients undergoing osteosynthesis of the upper limb under brachial plexus block, randomly assigned to two groups. METHODS: The patients of the control group were given 0.5% bupivacaine 1 mg.kg-1 and 1% lidocaine 2 mg.kg-1. Those of the sufentanil group, received the same mixture supplemented with sufentanil 0.2 mg.kg-1. During the postoperative period, the characteristics of analgesia were blindly evaluated every hour for 48 h with a visual analogic scale graduated from 0 to 100. Analgesia was considered satisfactory when the score was below 30. Adverse effects of opiates (drowsiness, pruritus, nausea and vomiting) were also assessed. Oxygen saturation was continuously monitored. Blood pressure, heart and respiratory rates were measured at the same intervals than analgesia. Duration of analgesia are expressed as medians (range) and compared using a Mann and Whitney's U test. RESULTS: The respective durations of satisfactory analgesia were significantly different: 12.5 h (8-17) in the control group versus 24 h (8-48) for the sufentanil group. The adverse effects in the sufentanil group were nausea (2), vomiting (1) and pruritus (1). No respiratory depression was noted. CONCLUSION: Sufentanil added to a mixture of lidocaine and bupivacaine increases twofold the duration of postoperative analgesia following branchial plexus blockade.

The addition of opioids to local anaesthetics in brachial plexus block: the comparative effects of morphine, buprenorphine and sufentanil.

We compared the duration of analgesia produced by a mixture of lignocaine and bupivacaine, either alone or combined with morphine (75 micrograms.kg-1), buprenorphine (3 micrograms.kg-1) or sufentanil (0.2 microgram.kg-1) in 80 patients after brachial plexus block for orthopaedic surgery of the upper limb. The characteristics of analgesia were evaluated hourly using a visual analogue scale. The analgesia was considered satisfactory for scores of 30 or less. The median duration (range) of satisfactory analgesia was: 11.5 (8-15) h without an opioid, 21 (9-27) h with morphine, 20 (14-34) h with buprenorphine and 24.5 (11-38) h with sufentanil. We conclude that the addition of an opioid to a local anaesthetic mixture lengthens the duration of analgesia.

[Comparison of fentanyl and alfentanil in ambulatory anesthesia]. / Comparaison fentanyl-alfentanil lors d'anesthésies ambulatoires.

PIP: The development of ambulatory surgery has favored use of rapidly eliminated anesthetic agents or at least those whose clinical effects are easily predictable. Central analgesics such as fentanyl have not been very satisfactory; fentanyl is believed to have a short duration of action, but it has also been found to have a long half-life. A comparative study was conducted to determine whether the newer alfentanil would be more suitable for use in ambulatory surgery. 30 patients undergoing induced abortions arrived fasting at the hospital on the morning of the operation and were premedicated intravenously with .18 mg/kg midazolan and 2.2 mcg/kg of fentanyl or 24.2 mcg/kg of alfentanil. The efficacy of the premedication was assessed 5 minutes later just prior to anesthesia induction, which was achieved with 40 mcg/kg of alphadione. The delay to sleep was assessed by the disappearance of reflexes and of pain reaction. The delay to awakening was assessed by spontaneous opening of the eyes, response to a simple command, and unaided sitting up. Psychometric tests were administered 2 and 4 hours after anesthesia and compared to preoperative performance of the same tests. The 15 fentanyl and 15 alfentanil patients did not differ significantly in height, weight, or age. Premedication was considered good in the 15 fentanyl patients but excessive in 7 of the 15 alfentanil patients because of depressed respiration. There were no significant differences in pulse rate in the 2 groups. Systolic blood pressure diminished significantly in the 2 groups after induction but values returned to normal after 3 minutes. The respiratory response was significantly more marked and more prolonged in the alfentanil group, with respiratory frequency declining from 18 to 9 breaths/minute with 3 apnea episodes for 15 patients. Respiratory frequency declined from 19 to 15 breaths/minute in the fentanyl group. The average delay to sleep was shorter in the alfentanil group but the difference was not statistically significant. The duration of the operations was comparable in the 2 groups. Reinjection of analgesic was necessary for a few patients in each group. The difference was not statistically significant although the anesthesia appeared more stable in the alfentanil group. Awakening time appeared more rapid in the alfentanil group but the difference was not statistically significant. There was no significant difference in the test results for the 2 groups 2 and 4 hours after anesthesia. The results of this study do not appear to provide a decisive argument in favor or alfentanil for short term anesthesia.^ieng