Patient-controlled analgesia with sufentanil: A comparison of two different methods of administration

Study Objective: To examine the safety and analgesic efficacy of sufentanil administered via either epidural or intravenous (IV) patient- controlled analgesia (PCA) in patients recovering from gynecologic surgery. Design: Randomized, double-blind comparison. Setting: Patient care unit at a university medical center. Patients: 29 healthy women presenting for major intraabdominal gynecologic surgery with epidural anesthesia who requested postoperative PCA. Interventions: Following completion of surgery performed using epidural anesthesia with 2% lidocaine and IV sedation, patients were assigned to one of three treatment groups: Group 1-epidural PCA (EPCA) with sufentanil: 0.3 μg/kg bolus followed by 8 μg/hr infusion plus epidural PCA boluses of 4 μg every 6 min as needed; Group 2-IV PCA with sufentanil: 0.3 μg/kg bolus followed by 8 μg/hr infusion plus IV PCA boluses of 4 μg every 6 min as needed; or Group 3-IV PCA with morphine: 0.1 mg/kg bolus followed by 0.5 mg/hr infusion plus IV PCA boluses of 1 mg every 6 min as needed. Measurements and Main Results: Patients were observed at regular intervals during a 24-hour evaluation period. Visual analog scale (VAS) scores were used to assess analgesia and satisfaction with therapy. Pulmonary function was assessed by monitoring respiratory rate, oxygen (O₂) saturation, and forced expiratory flow. Total opioid dose delivered and the presence/severity of side effects was also collected. Sufentanil plasma levels were measured in a subset of eight patients. Patients receiving either EPCA or IV PCA sufentanil experienced equivalent analgesia that was more rapid in onset than IV PCA morphine. Total dose administered and plasma concentration of drug were similar in both sufentanil groups; however, a greater number of patients in the IV delivery group experienced clinically significant O₂ desaturation. Conclusions. The main advantage of EPCA sufentanil in this postsurgical setting was its ability to provide a more rapid onset of analgesia than traditional IV PCA with morphine while offering greater safety than IV sufentanil.