title: Comparison of epidurally administered sufentanil, morphine, and sufentanil-morphine combination for postoperative analgesia.
abstract: Postoperative analgesia provided by epidurally administered sufentanil and/or morphine was evaluated in 45 patients recovering from major gynecologic surgery. At the first complaint of pain in the Postanesthesia Care Unit, patients received a single epidural bolus of 30 micrograms sufentanil (group A), 5 mg morphine (group B), or 30 micrograms sufentanil plus 3 mg morphine (group C) in a randomized blinded fashion. Analgesic efficacy was assessed throughout the 24-h study period with 10-cm visual analog scales. The need for additional postoperative analgesia (patient-controlled analgesia, 1 mg of morphine every 6 min as necessary) and the incidence of adverse effects were also assessed. Patients receiving sufentanil (groups A and C) had significantly faster onset of analgesia than did patients given morphine alone (group B, P less than 0.05). Group B subjects experienced the longest duration of analgesia (B vs A and C, P less than 0.05) and required significantly less patient-controlled analgesia (morphine) than patients in group A (P less than 0.05). No patient developed clinically significant respiratory depression or excessive sedation, and there were no intergroup differences in incidence of pruritus or nausea (P value not significant). The data indicate that a mixture of sufentanil and morphine provides either a more rapid onset of epidural analgesia or reduced patient-controlled analgesia narcotic requirement than respective doses of each agent administered alone.
authors.affiliation: Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut 06510.
authors.forename: R S
authors.initials: RS
authors.lastname: Sinatra
authors.forename: F B
authors.initials: FB
authors.lastname: Sevarino
authors.forename: J H
authors.initials: JH
authors.lastname: Chung
authors.forename: G
authors.initials: G
authors.lastname: Graf
authors.forename: D
authors.initials: D
authors.lastname: Paige
authors.forename: V
authors.initials: V
authors.lastname: Takla
authors.forename: D G
authors.initials: DG
authors.lastname: Silverman
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000031:analogs & derivatives*; D006801:Humans; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D011897:Random Allocation; D012646:Self Administration; D017409:Sufentanil
chemical_list: D009020:Morphine; D017409:Sufentanil; D005283:Fentanyl