Using High-Dose Sufentanil Intrathecally For Painless Induction And Postoperative Pain Management In Gastrointestinal Cancer Surgeries

Document Type : Original Article

Authors

1 Associate Professor, Department of Anesthesia, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Associate Professor, Department of Epidemiology , School of Health, Mashhad University of Medical Sciences, Mashhad, Iran

3 Anesthesiologist, Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Background: Intrathecal opioids have demonstrated efficacy in pain management during and after surgery, necessitating further exploration across various surgical procedures. This study examines the use of higher doses of intrathecal synthetic opioids (Sufentanil) for pain control in gastrointestinal cancer surgeries, highlighting the need for additional research to establish conclusive outcomes.
 
Methods: A single-center clinical trial with a control group was conducted, involving adult non-addicted individuals eligible for gastrointestinal cancer surgeries. The intervention group (n=25) received intrathecal Sufentanil (0.2 mcg/kg) before anesthesia induction, while the control group (n=25) received intravenous Sufentanil (0.3 mcg/kg) at induction. The variables between the two groups were compared using chi-square tests, independent t-tests, and exact tests.
 
Results: The average age in the intrathecal group was 55.1 years ± 9.3, and in the intravenous administration group was 54.2 years ± 13.2, showing no significant difference (p=0.4). A higher proportion of patients in the intrathecal group required three analgesic doses (52%) compared to the IV group, where 44% needed four doses during surgery, with no significant variance observed between groups (p=0.3). Postoperative pain scores were lower in the intrathecal group than in the intravenous administration group (0.8 ± 1.7 vs 0.66 ± 5.12, p<0.001).
 
Conclusion: Based on our study findings, Intrathecal Sufentanil at a dose of 0.2 mcg/kg reduces postoperative pain by one-third compared to IV administration in gastrointestinal cancer surgeries.

Keywords


Acknowledgements: The authors sincerely appreciate the support and collaboration of colleagues, medical staff, and all those who contributed to this study. Their assistance and insights were invaluable in completing this research.

 

Availability of data and materials: The data and materials related to this study are available from the corresponding author, Naser Naderi, upon reasonable request.

 

Conflicts of interests: The authors declare that they have no conflicts of interest.

 

Consent for publication: Not Applicable

 

Ethics approval and consent to participate: This study was conducted based on research project No. 990848, approved on 2020/10/03, and the ethics committee approval No. IR.MUMS.MEDICAL.REC.1399.580, approved on 2020/11/17, with the title: "Using high-dose Sufentanil intrathecally for painless induction and postoperative pain management in gastrointestinal cancer surgeries." Additionally, the study adhered to the principles outlined in the Declaration of Helsinki.

 

Financial disclosure: The authors declare that no financial support, grants, or funding was received for the research, authorship, and/or publication of this manuscript.

 

Author contributions: All authors contributed equally to the research, writing, and revision of this manuscript.

 

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

1. Savoia G, Loreto M, Gravino E. Sufentanil: an overview of its use for acute pain management. Minerva Anestesiologica. 2001 Sep 1;67(9; SUPP/1):206-16.
 
2. Bernards CM. Understanding the physiology and pharmacology of epidural and intrathecal opioids. Best Practice & Research Clinical Anaesthesiology. 2002;16(4):489-505.
https://doi.org/10.1053/bean.2002.0255
PMid:12516887  
 
3. Bernards CM, Shen DD, Sterling ES, Adkins JE, Risler L, Phillips B, et al. Epidural, cerebrospinal fluid, and plasma pharmacokinetics of epidural opioids (part 1) differences among opioids. The Journal of the American Society of Anesthesiologists. 2003;99(2):455-65.  
 
4. Rathmell JP, Lair TR, Nauman B. The role of intrathecal drugs in the treatment of acute pain. Anesthesia & Analgesia. 2005;101(5S):S30-S43.
https://doi.org/10.1213/01.ANE.0000177101.99398.22
PMid:16334491  
 
5. Gropper MA, Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Cohen NH, et al. Miller's anesthesia, 2-volume set E-book: Elsevier Health Sciences; 2019.  
 
6. Van Zundert J, Rauck R. Intrathecal drug delivery in the management of chronic pain. Best Practice & Research Clinical Anaesthesiology. 2023 Jun 1;37(2):157-69.
https://doi.org/10.1016/j.bpa.2023.02.003
PMid:37321764  
 
7. Jensen MP, Chen C, Brugger AM. Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain. The Journal of pain. 2003;4(7):407-14.
https://doi.org/10.1016/S1526-5900(03)00716-8
PMid:14622683  
 
8. Ummenhofer WC, Arends RH, Shen DD, Bernards CM. Comparative spinal distribution and clearance kinetics of intrathecally administered morphine, fentanyl, alfentanil, and sufentanil. The Journal of the American Society of Anesthesiologists. 2000;92(3):739-53.
https://doi.org/10.1097/00000542-200003000-00018
PMid:10719953  
 
9. D'Angelo R, Anderson MT, Philip J, Eisenach JC. Intrathecal sufentanil compared to epidural bupivacaine for labor analgesia. Anesthesiology. 1994;80(6):1209-15.
https://doi.org/10.1097/00000542-199406000-00007
PMid:8010467  
 
10. Ferouz F, Norris MC, Arkoosh VA, Leighton BL, Boxer LM, Corba RJ. Baricity, needle direction, and intrathecal sufentanil labor analgesia. The Journal of the American Society of Anesthesiologists. 1997;86(3):592-8.
https://doi.org/10.1097/00000542-199703000-00010
PMid:9066324  
 
11. Stevens RA, Petty RH, Hill HF, Kao T-C, Schaffer R, Hahn MB, et al. Redistribution of sufentanil to cerebrospinal fluid and systemic circulation after epidural administration in dogs. Anesthesia & Analgesia. 1993;76(2):323-7.  
 
12. Menigaux C, Guignard B, Fletcher D, Sessler DI, Levron JC, Chauvin M. More epidural than intravenous sufentanil is required to provide comparable postoperative pain relief. Anesthesia & Analgesia. 2001 Aug 1;93(2):472-6.
https://doi.org/10.1097/00000539-200108000-00046
PMid:11473882  
 
13. Camann WR, Denney RA, Holby ED, Datta S. A comparison of intrathecal, epidural, and intravenous sufentanil for labor analgesia. The Journal of the American Society of Anesthesiologists. 1992;77(5):884-7.
https://doi.org/10.1097/00000542-199211000-00008  
 
14. Hansdottir V, Hedner T, Woestenborghs R, Nordberg G. The CSF and plasma pharmacokinetics of sufentanil after intrathecal administration. Anesthesiology. 1991;74(2):264-9.
https://doi.org/10.1097/00000542-199102000-00012
PMid:1671323  
 
15. Fournier R, Weber A, Gamulin Z. Intrathecal sufentanil is more potent than intravenous for postoperate analgesia after total-hip replacement. Regional Anesthesia & Pain Medicine. 2005;30(3):249-54.
https://doi.org/10.1097/00115550-200505000-00007
PMid:15898028  
 
16. Nigro Neto C, Amaral JLGd, Arnoni R, Tardelli MA, Landoni G. Intrathecal sufentanil for coronary artery bypass grafting. Revista Brasileira de Anestesiologia. 2014;64:73-8.
https://doi.org/10.1016/j.bjane.2012.12.004
PMid:24794447  
 
17. Andrew Bowdle T. Adverse effects of opioid agonists and agonist-antagonists in anaesthesia. Drug safety. 1998 Sep;19:173-89.
https://doi.org/10.2165/00002018-199819030-00002
PMid:9747665