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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

It is generally accepted that analgesia induced by central analgesics is mediated through the mu-receptor. However, it still remains open to question as to whether or not the mu- and/or the delta-receptor site is mainly involved in the mediation of opioid-related respiratory impairment. Using a highly selective antagonist, naltrindole (NTI), or its benzofuran analogue naltriben (NTB), the hypothesis that competitive antagonism at the delta-receptor is able to attenuate sufentanil-related respiratory depression was tested in the dog. High dose (20 micrograms kg-1) sufentanil-induced respiratory impairment could be reversed by selective NTI-antagonism in a dose-related fashion (40-80-160 micrograms kg-1) increasing PaO2 from 57 to 81 mmHg and lowering PaCO2 from 52.1 to 49.2 mmHg. NTB-antagonism (40-80-160 micrograms kg-1) increased PaO2 from 48.4 to 91.2 mmHg and reduced PaCO2 from 46.9 to 37.6 mmHg. Simultaneously, somatosensory-evoked potentials (SEP) were used to quantify the opioid-induced attenuation and the reversal of afferent sensory input to pain modulating centres in the CNS. Sufentanil induced a significant depression (P < 0.01) of amplitude height of the SEP (13.9 to 0.9 microV in the NTI- and 8.8 microV to 1.3 microV in the NTB-group) which was only partially reversed by NTI (2.6 microV) and NTB (2.3 microV) respectively. The results suggest that delta-receptors are involved in sufentanil-related respiratory impairment. These receptors play a minor role in opioid-induced attenuation of sensory input to the brain. Highly selective delta-antagonists may be of clinical interest in reversing the respiratory depressant effect of potent opioids while maintaining analgesia.
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PMID:The delta receptor is involved in sufentanil-induced respiratory depression--opioid subreceptors mediate different effects. 133 May 49

Although morphine and fentanyl remain the predominant epidural opioids, sufentanil offers some unique advantages. Because of its greater lipophilicity and mu-receptor binding capacity, sufentanil has a faster onset of action and longer duration than epidural fentanyl. Compared with morphine, sufentanil has been associated with a lower incidence of side effects, particularly delayed respiratory depression. The effective doses and adverse effects profile of epidural sufentanil are relatively well understood. Ventilatory depression is minimal with both bolus and continuous administration. Rapid vascular uptake after large epidural bolus, however, has been associated with acute-onset respiratory depression and even respiratory arrest. Sufentanil is more ideally suited than morphine to continuous epidural administration. The faster onset in comparison with fentanyl may make sufentanil the ideal agent for patient-controlled epidural analgesia. The synergistic effect of combined sufentanil and low-concentration bupivacaine offers advantages over sufentanil alone. High doses of epidural sufentanil have been uniquely associated with cessation of shivering and hypothermia. As with fentanyl, the intrathecal administration of sufentanil for postoperative analgesia is limited by its short duration of action.
J Pain Symptom Manage 1992 Jul
PMID:Sufentanil: clinical use as postoperative analgesic--epidural/intrathecal route. 135 35

This review considers a few of the controversies and most recent data pertaining to the clinical intraoperative use of the potent opioid sufentanil. Although sufentanil is used extensively as the opioid component of "balanced" anesthesia, opioids themselves are not total anesthetics. Sufentanil is effective in reducing the so-called stress responses that can occur with balanced anesthesia. Although no conclusive data have shown that such reduction in stress response improves anesthetic outcome, many clinicians continue to choose sufentanil for both convenience and improved hemodynamic control. Recent pharmacokinetic modeling suggests that sufentanil would be a good choice for balanced anesthesia. Additionally, initial postoperative analgesia appears to work better when sufentanil rather than fentanyl is used intraoperatively. Although cost considerations remain important, cost analysis would suggest that, on a per-patient basis, choice of intraoperative opioid has very little effect on total hospital costs.
J Pain Symptom Manage 1992 Aug
PMID:Clinical use of sufentanil as an anesthetic. 138 74

The pharmacokinetics, pharmacodynamics, and clinical uses of fentanyl, sufentanil, and alfentanil are reviewed. The fentanyl derivatives have reduced or eliminated many of the disadvantages of opioid anesthetics, such as incomplete amnesia and undesirable hemodynamic responses to surgery. Fentanyl is 50-100 times as potent as morphine and was the first of the three to be marketed. Sufentanil is even more potent than fentanyl. Alfentanil has the fastest onset of action, followed by sufentanil and then fentanyl. Alfentanil also has the shortest duration of action of the group. Most studies of these agents have been done to assess their role as anesthetics in cardiac surgery. All three provide cardiovascular stability when administered before noxious surgical stimuli, except when given as a single bolus during the induction of anesthesia. All seem to produce adequate anesthesia, particularly when used in combination with nitrous oxide. Because of its short duration of action, alfentanil is preferred for brief procedures or when rapid changes in the level of consciousness are desired. All three agents have also been used for analgesia; epidural administration provides adequate relief of pain. Fentanyl has been formulated as a transdermal patch that seems to provide the same degree of analgesia as a continuous i.v. infusion. Fentanyl has also been formulated as an investigational lozenge that has shown advantages as a preoperative sedative in children. As more is learned about these agents, their perioperative uses for anesthesia, analgesia, and sedation will continue to be refined.
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PMID:Clinical uses of fentanyl, sufentanil, and alfentanil. 183 93

Sufentanil 25 micrograms plus clonidine 1 microgram/kg administered epidurally was compared with epidural sufentanil 50 micrograms alone in a double-blind fashion for pain relief in 40 patients after abdominal surgery. The duration of complete pain relief was significantly longer in those who received the mixture. Oxygen saturation was reduced 10 and 20 minutes after sufentanil alone, but remained stable after sufentanil and clonidine. There were significant decreases in arterial blood pressure in the latter group that were maximum between 20 and 120 minutes after administration.
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PMID:Comparison of epidural sufentanil plus clonidine with sufentanil alone for postoperative pain relief. 214 38

Pattern of drug consumption and side effects of sufentanil and alfentanil were compared to morphine, using "on-demand" patient-controlled analgesia (PCA). After a non-narcotic general anesthetic, a bolus dose of the narcotic was given intravenously towards the end of surgery. PCA was started in the recovery room. Data were retrieved postoperatively for a total of 24 h. Results showed a wide range of pattern of drug consumption and uniform acceptance of therapy by the nurses and the patients in all the groups. The frequency of use of incremental doses was greater than 2-2.5-fold for the sufentanil and alfentanil groups, respectively, compared with morphine. The bolus dose of the narcotics failed to achieve adequate analgesia for 2 h for morphine and sufentanil and for 6 h for alfentanil. Overall patients were most sedated with morphine and least sedated with sufentanil. At the time intervals sampled, there was a higher incidence of oxygen desaturation--less less than 95% with morphine and alfentanil, compared with sufentanil. There was a similar incidence of nausea in all the groups. Further study is needed to determine precisely the best dose regimens for sufentanil and alfentanil, especially in reference to optimum loading doses. Sufentanil appears to be a promising drug for PCA use.
Clin J Pain 1989
PMID:Sufentanil and alfentanil pattern of consumption during patient-controlled analgesia: a comparison with morphine. 252 Apr 34

Fifteen patients with cancer pain refractory to other methods of pain control were treated with epidural sufentanil. They all suffered from very severe or unbearable pain but had expressed the wish to spend the last period of their lives at home. On the first day of hospitalization, an epidural catheter and a portal catheter were implanted under local anesthesia. Sufentanil was delivered by a portable infusion pump into the portal catheter. The patients remained a further 2-3 days in hospital to titrate the infusion rate to their specific needs and to monitor pain relief and possible side effects. In the home situation, the patients were supervised by their general practitioners. Nine patients had epidural sufentanil as their sole analgesic till they died; six patients needed adjunctive nonepidural medications. There were no epidural- or portal-catheter related infections or cases of respiratory depression. After 1651 patient treatment days, we have found continuous epidural sufentanil infusion to be a safe and effective method for cancer pain control in outpatients.
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PMID:Epidural sufentanil for cancer pain control in outpatients. 257 54

Sufentanil as a supplement to halothane/N2O anaesthesia was evaluated in 32 unpremedicated infants and children age 6 months to 9 yr undergoing elective orthopaedic surgery. Patients were randomly assigned in a double-blind manner to receive one of four intravenous supplements: placebo, sufentanil 0.5, 1.0 or 1.5 micrograms.kg-1. Systolic arterial pressure (SAP), heart rate (HR) and end-tidal halothane concentration were recorded before and after induction, supplement administration, tracheal intubation, incision and every 15 min during the procedure. Venous catecholamine samples were obtained before and after incision. A pain score was assigned to the patients in the postanaesthesia care unit (PACU). Sufentanil at all three doses prevented increases in SAP and HR with intubation and incision, provided superior pain relief in the PACU and did not prolong wake-up time. Sufentanil 1.0 and 1.5 micrograms.kg-1 allowed for a reduction in the halothane requirements. Sufentanil 1.5 micrograms.kg-1 was associated with lower catecholamine levels than in the placebo group following incision. Sufentanil supplementation at 1.0 and 1.5 micrograms.kg-1 was associated with bradycardia and/or hypotension during induction and an increased incidence of vomiting during the first 24 hours postoperatively. One patient in the sufentanil 1.0 micrograms.kg-1 group whose surgical time was less than 45 min exhibited respiratory depression in the PACU requiring narcotic reversal. In conclusion, sufentanil 0.5 micrograms.kg-1 improved immediate postoperative pain relief and is acceptable as a supplement during halothane anasethesia in infants and children. The associated side effects of larger doses of sufentanil (1.0 and 1.5 micrograms.kg-1) make their use as a supplement to halothane anaesthesia unacceptable.
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PMID:Low-dose sufentanil as a supplement to halothane/N2O anaesthesia in infants and children. 290 84

Sufentanil, an opioid analgesic, is an analogue of fentanyl, and has been used for the induction and maintenance of anaesthesia, and for postsurgical analgesia. It has shorter distribution and elimination half-lives, and is a more potent analgesic than fentanyl. In clinical practice, however, intravenously administered sufentanil produces essentially equivalent anaesthesia to fentanyl and is a better anaesthetic than morphine or pethidine (meperidine) for major surgery. It would appear to maintain haemodynamic stability during surgery better than other opioids or inhalational anaesthetics. Postoperative respiratory depression has been reported in a few patients. For outpatient surgery, intravenous sufentanil produces equivalent anaesthesia to isoflurane or fentanyl. Recovery tends to be more rapid after sufentanil and the requirement for postoperative analgesia is less. Initial clinical trials with sufentanil administered epidurally to relieve pain during labour have produced encouraging results, but further studies are required to establish the drug's role in this indication. Epidural sufentanil produces a more rapid onset and better initial quality of analgesia than morphine, buprenorphine or hydromorphine when administered postoperatively, but the duration of analgesia is shorter. Thus, sufentanil's primary place in therapy at this time would appear to be as high dose anaesthesia for major surgery such as cardiac surgery, and as low dose supplement to balanced anaesthesia in general surgery. In addition, low doses administered epidurally seem to have a potential role for analgesia during labour or after surgery although further studies are required to clarify this situation.
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PMID:Sufentanil. A review of its pharmacological properties and therapeutic use. 290 21

Sufentanil (mean total dose 2 micrograms/kg) was compared with fentanyl (mean total dose 15 micrograms/kg) as a supplement to 60% N2O anesthesia in 30 adult patients undergoing general surgical procedures. Comparisons were made with respect to stability of hemodynamic variables (heart rate and systolic and diastolic blood pressure), changes in stress hormones (cortisol, antidiuretic hormone, epinephrine, norepinephrine, and dopamine), recovery of alertness and orientation, time to extubation, postoperative analgesia, and measures of respiratory depression (resting end-tidal carbon dioxide tension [PETCO2], CO2 response curve for minute ventilation [delta VE/delta PETCO2]). Hemodynamic variables remained stable and similar in both groups throughout the study. Plasma hormone levels remained similar to baseline in both groups until 1 h postoperatively when epinephrine levels were significantly elevated in both groups (P less than 0.05). Recovery times, including time to extubation, were similar in both groups. Patients given sufentanil had less pain 30 min postoperatively than those given fentanyl, although at 60 min postoperatively pain levels were similar in both groups. Small but significant elevations in resting PETCO2 were seen in both groups postoperatively (P less than 0.05), but postoperative delta VE/delta PETCO2 responses were significantly depressed only in patients receiving fentanyl (P less than 0.05). The results of this study demonstrate that sufentanil-N2O anesthesia is as effective as fentanyl-N2O in attenuating the hemodynamic and hormonal responses to the stress of general surgery. Because continuous intraoperative PETCO2 monitoring was not employed in this study, intraoperative hypocapnea cannot be strictly excluded as a possible influence on the postoperative measures of ventilatory drive.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Comparison of sufentanil-N2O and fentanyl-N2O in patients without cardiac disease undergoing general surgery. 294 75


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