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The impact of intra‐operative sufentanil dosing on post‐operative pain, hyperalgesia and morphine consumption after cardiac surgery
Author(s) -
Fechner J.,
Ihmsen H.,
Schüttler J.,
Jeleazcov C.
Publication year - 2013
Publication title -
european journal of pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.305
H-Index - 109
eISSN - 1532-2149
pISSN - 1090-3801
DOI - 10.1002/j.1532-2149.2012.00211.x
Subject(s) - sufentanil , medicine , anesthesia , morphine , propofol , hyperalgesia , cardiac surgery , dosing , surgery , nociception , receptor
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/m L (group SL , n = 20) or 0.8 ng/m L (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. Discussion 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/m L may be preferable.