Epidural sufentanil for post-operative pain relief: effects of adrenaline.

The analgesic, respiratory and haemodynamic effects of epidural sufentanil 75 micrograms (Group 1) or sufentanil 75 micrograms with adrenaline 75 micrograms (Group 2) were studied in 20 patients following abdominal surgery in a double-blind randomized trial. Pain relief, assessed on a linear analogue scale, sedation, heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR) and arterial carbon dioxide tension (PaCO2) were recorded before, and for 12 h after, injection. Good post-operative pain relief was obtained after 4 min in Group 1 and 6 min in Group 2. All patients in both groups were pain-free after 30 min. Analgesia lasted for 450 +/- 46 min in Group 1 and 690 +/- 92 min in Group 2 (P less than 0.05). Coughing and active movement was possible with little pain for 6 h post-operatively in Group 1 and 7 h in Group 2. The respiratory rate was significantly decreased from 15 min to 1 h after injection in Group 1 compared with Group 2 (P less than 0.05) and in three patients in Group 1 it was necessary to stimulate the patients verbally to maintain adequate respiration. PaCO2 increased significantly in both groups over the first 2 h. The patients in Group 1 showed more marked sedation 1 h after injection. Changes of HR and MAP were similar in both treatment groups. Side-effects were observed more frequently in Group 2, although the differences were not significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Analgesic and cardiorespiratory effects of epidural sufentanil and morphine in humans.

Thirty patients undergoing abdominal surgery were randomly assigned postoperatively into two groups for a double-blind evaluation of the analgesic potency and cardiorespiratory effects of either 50 micrograms sufentanil or 5 mg morphine injected epidurally. After sufentanil injection, good postoperative analgesia was obtained, with a linear analog score (LAS) of less than 5 starting 5 min after injection and lasting for more than 6 hr. Linear analog scores obtained during coughing (LASC) and during movement (LASM) were less than 5 after 10 min and lasted for more than 4 hr. Respiratory rate decreased significantly for 2 hr after sufentanil injection. After morphine, pain relief started after 20 min and lasted for more than 12 hr. Respiratory rate decreased after 30 min. Sedation was greater after sufentanil than after morphine. PaCO2, which increased significantly 1 hr after sufentanil, did not change after morphine. Peak expiratory flow significantly improved for 2 hr after both sufentanil and morphine, whereas forced vital capacity improved for 4 hr after sufentanil and 8 hr after morphine administration. Forced expiratory volume did not change with either drug. It is concluded that 5 mg morphine injected epidurally provides longer lasting analgesia than does 50 micrograms sufentanil, but that in the first hours analgesia is better after sufentanil. Injection of either drug was accompanied by remarkable cardiovascular stability.

Meptazinol for postoperative pain relief in man. Comparison of extradural and i.m. administration.

The analgesic and cardiorespiratory effects of meptazinol 90 mg, given by the extradural or the i.m. route, were studied in 32 postoperative patients. Plasma meptazinol concentrations were measured in five patients in each treatment group. Evaluation using a linear analogue scale indicated that there were significant differences between the groups in the onset, quality and duration of pain relief, with the extradural route being superior to the i.m. route in each instance. The difference in quality of pain relief was not related to the resultant plasma meptazinol concentrations, which were similar in the two groups. Ventilatory rate was decreased equally in both groups in parallel with pain relief, but no incidence of overt respiratory depression was noted. Meptazinol produced no meaningful changes in measured cardiovascular variables, and side effects were minimal in both groups.

Epidural sufentanil for postsurgical pain relief.

This study aimed to determine the safest and most effective dose of sufentanil for epidural administration to relieve post-operative pain. Thirty healthy patients were treated following abdominal surgery. They received no opiates in premedication nor peroperatively. After surgery, upon occurrence of pain, they received a single epidural injection of sufentanil (30, 50 or 75 micrograms) according to a randomized protocol. Pain intensity was evaluated using a visual analogue scale (VAS). Arterial blood gases, peak flow (PF) and forced vital capacity (FVC) were measured before, and at 1, 2 and 4 h post-operatively. The onset of the analgesic effect was evident within 5 min, and was significantly faster with 75 micrograms sufentanil than with either of the other two doses (P less than 0.05). The maximal effect occurred at 30 min, and lasted for 4 h (VAS less than 5) irrespective of the dose injected. Respiratory rate decreased at most by 24% and post-operative sedation was increased for approximately 2 h, both effects being dose-related. Arterial PCO2, heart rate and mean arterial pressure remained normal. Two hours after the injection, there was a small increase in FVC and PF.