Immediate postoperative pain management in patients undergoing major abdominal surgery after remifentanil-based anesthesia: sufentanil vs tramadol.
OBJECTIVE
The transition from intraoperative analgesia to postoperative analgesia must be planned carefully after remifentanil-based anesthesia, due to the short duration of action of remifentanil. The aim of this study is to compare the efficacy and safety of 2 transition strategies using sufentanil or tramadol for early postoperative pain relief in patients who had major abdominal surgery under general anesthesia with remifentanil/sevoflurane.


METHODS
Sixty patients participated in this double-blind, prospective study and were randomly assigned to either sufentanil (S) group or tramadol (T) group. Twenty minutes before the end of surgery the patients received either a bolus of 0.15 microg kg(-1) sufentanil (group S) or tramadol 100 mg (group T). Mean arterial pressure (MAP), heart rate (HR) and rate pressure product (RPP=systolic arterial pressure (SAP)xHR), analgesia by a verbal rating score (VRS) and sedation by a sedation score (SS) were evaluated at emergence from anesthesia.


RESULTS
A statistically significant difference in HR between the 2 groups was recorded at extubation (78+/-13 in group S vs 86+/-24 in group T). A significant decrease of RPP values at extubation and 5 minutes later were found in group S in comparison with group T. VRS values were significantly lower in sufentanil group at 5 and 10 minutes after awakening.


CONCLUSIONS
Sufentanil provided more effective transition analgesia in comparison with tramadol. The effects of remifentanil dissipated rapidly and analgesia with major opioids was required. A bolus dose of sufentanil 0.15 microg kg(-1) was efficacious in controlling the hemodynamic parameters at awakening from anesthesia. The lower HR values and, consequently the lower RPP values are of utmost importance especially in the aged cardiovascular risk patient.
Department of Anesthesia, Postoperative Intensive Care, Burn Center and Hyperbaric Center A. Cardarelli Hospital, Naples, Italy. tcafiero@tiscali.it
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D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D000762:Anesthesia Recovery Period; D000771:Anesthesia, Intravenous / Q000009:adverse effects; D018686:Anesthetics, Intravenous / Q000009:adverse effects; D004311:Double-Blind Method; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy*; D010880:Piperidines / Q000009:adverse effects; D011446:Prospective Studies; D000077208:Remifentanil; D017409:Sufentanil / Q000009:adverse effects / Q000627:therapeutic use*; D014147:Tramadol / Q000627:therapeutic use*
D000701:Analgesics, Opioid; D018686:Anesthetics, Intravenous; D010880:Piperidines; D014147:Tramadol; D017409:Sufentanil; D000077208:Remifentanil