Inflammation increases sufentanil requirements during surgery for inflammatory bowel diseases.
OBJECTIVE
Inflammation promotes hyperalgesia and increases opioid binding protein (alpha1-acid glycoprotein) inducing increased opioid requirement. To investigate the influence of an acute episode of inflammatory bowel disease in opioid requirement during major abdominal surgery, 17 patients with Crohn's disease, 12 patients with ulcerative colitis and seven patients without any inflammatory process (control group) were prospectively studied. Sufentanil requirements were assessed during surgery.


METHODS
Sufentanil administration was adjusted when haemodynamic variables changed more than 20% of preoperative values. In a subgroup of 20 patients (Crohn's disease: 7, ulcerative colitis: 7, control group: 6), plasma concentrations of alpha1-acid glycoprotein and unbound sufentanil were measured. Total plasma clearance of sufentanil was also determined. Data presented as median (25-75 per thousand) were analysed by non-parametric and ANOVA tests.


RESULTS
Despite similar surgery duration, intraoperative sufentanil requirements were significantly larger in both the Crohn's disease group (0.9 (0.6-1.6) microg kg(-1) h(-1)) and the ulcerative colitis group (1.1 (0.6-1.7) microg kg(-1) h(-1)) than in the control group (0.5 (0.4-0.5) microg kg(-1) h(-1)). Total plasma clearance of sufentanil was larger in patients with inflammatory bowel disease than in the control group. The plasma alpha1-acid glycoprotein concentration was increased in the inflammatory bowel disease group. However, the free fraction of sufentanil was similar in all three groups. The largest sufentanil consumption in patients with inflammatory bowel disease was observed during time of pain stimulation in the area of referred hyperalgesia from the affected viscus. In the control group, the sufentanil requirement was constant throughout surgery.


CONCLUSIONS
Inflammatory bowel disease increases opioid requirement during major abdominal surgery.
Guidat
A
A
Hôpital Claude Huriez, Département d'Anesthésie Réanimation 2, Lille, France. a-guidat@chru-lille.fr
Fleyfel
M
M
Vallet
B
B
Desreumaux
P
P
Levron
J C
JC
Gambiez
L
L
Colombel
J F
JF
Scherpereel
P
P
D000328:Adult; D000701:Analgesics, Opioid / Q000097:blood / Q000493:pharmacokinetics; D000704:Analysis of Variance; D019540:Area Under Curve; D001799:Blood Sedimentation / Q000187:drug effects; D002097:C-Reactive Protein / Q000187:drug effects; D003093:Colitis, Ulcerative / Q000097:blood / Q000601:surgery*; D003424:Crohn Disease / Q000097:blood / Q000601:surgery*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006023:Glycoproteins / Q000097:blood; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000503:physiopathology*; D008297:Male; D011446:Prospective Studies; D012016:Reference Values; D017409:Sufentanil / Q000097:blood / Q000493:pharmacokinetics*; D013997:Time Factors
D000701:Analgesics, Opioid; D006023:Glycoproteins; D002097:C-Reactive Protein; D017409:Sufentanil