title: The impact of intra-operative sufentanil dosing on post-operative pain, hyperalgesia and morphine consumption after cardiac surgery.
abstract: BACKGROUND
  There is an ongoing debate whether opioids when used for intra-operative analgesia may enhance post-operative pain. We studied the effect of two different intra-operative dosings of sufentanil on post-operative morphine consumption, pain and hyperalgesia after cardiac anaesthesia.
  
  
  METHODS
  Forty-two male patients (age: 48-74 years) undergoing first-time coronary artery bypass graft surgery were randomized to one of two groups receiving total intravenous anaesthesia with propofol and a target controlled infusion of sufentanil with a target of 0.4 ng/mL (group SL, n = 20) or 0.8 ng/mL (group SH, n = 22) plasma concentration. Post-operative morphine requirement in the first 48 h was assessed using patient-controlled analgesia (PCA). Pain rating during deep inspiration, and the extent of primary and secondary hyperalgesia near the sternotomy wound were assessed.
  
  
  RESULTS
  The post-operative morphine requirements in the first 48 h were 0.68 ± 0.21 mg/kg in group SL and 0.96 ± 0.44 mg/kg in group SH (p < 0.05). In group SL, pain during deep inspiration was significantly lower on the first post-operative day (p < 0.05). Primary hyperalgesia had its maximum on the second and third post-operative day, without a difference between the two groups. The extent of secondary mechanical pinprick hyperalgesia was not different between the groups.
  
  
  CONCLUSIONS
  Intra-operative dosing of sufentanil significantly influenced post-operative morphine consumption, pain and hyperalgesia. For cardiac anaesthesia in combination with propofol, a sufentanil target concentration of 0.4 ng/mL may be preferable.
authors.affiliation: Department of Anaesthesiology, University of Erlangen-Nürnberg, Erlangen, Germany. joerg.fechner@kfa.imed.uni-erlangen.de
authors.forename: J
authors.initials: J
authors.lastname: Fechner
authors.forename: H
authors.initials: H
authors.lastname: Ihmsen
authors.forename: J
authors.initials: J
authors.lastname: Schüttler
authors.forename: C
authors.initials: C
authors.lastname: Jeleazcov
mesh_terms: D000368:Aged; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D001026:Coronary Artery Bypass / Q000379:methods*; D004311:Double-Blind Method; D006801:Humans; D006930:Hyperalgesia / Q000188:drug therapy / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000517:prevention & control*; D011184:Postoperative Period; D015742:Propofol / Q000627:therapeutic use; D017409:Sufentanil / Q000627:therapeutic use*
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine; D017409:Sufentanil; D015742:Propofol