Intrathecal fentanyl ／sufentanil enhance low-dosebupivacaine 椎管内芬太尼和舒芬

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Intrathecal fentanyl or sufentanil enhance low-dose bupivacaine spinal block

The addition of fentanyl or sufentanil to low-dose diluted bupivacaine provides adequate anesthesia without hemodynamic instability for elderly men undergoing transurethral resection of the prostate (TURP), research shows.

These lipophilic opioids have a synergistic effect ensuring an adequate level of sensory block, with the added benefit of the limited distribution of the spinal block and a comparably rapid recovery provided by low-dose diluted bupivacaine, the research team explains.

Limiting the distribution of the block is important in TURP, as most patients are elderly and frequently present with cardiac, pulmonary, or other diseases.

H. K. Kil and colleagues from Yonsei University College of Medicine in Seoul, South Korea, randomly assigned 70 patients undergoing TURP to receive fentanyl 25 μg plus bupivacaine 0.5% (0.8 mL) plus normal saline 0.3 mL, or sufentanil 5 μg plus bupivacaine 0.5% (0.8 mL) plus normal saline 0.7 mL. Spinal anesthesia was successfully accomplished in all the patients. The peak sensory block level was significantly higher in the 35 patients receiving sufentanil than in the 35 patients receiving fentanyl, but no significant differences occurred in the time to peak block level, time to two-segment regression, and the degree of motor block. None of the patients had complete motor block.

After the operation, significantly more patients in the fentanyl group than in the sufentanil group needed analgesics, at 20 (57.1%) versus nine (25.7%). Fentanyl-treated patients also needed analgesics significantly sooner than sufentanil-treated patients, with the first request at 7.0 hours versus 10.6 hours, respectively.

However, the two groups did not differ with regard to the onset and recovery time of the sensory block, quality of anesthesia, and adverse effects.

The researchers conclude that supplementing low-dose diluted bupivacaine with either fentanyl or sufentanil provides adequate anesthesia without hemodynamic instability for TURP in elderly patients. But they add: “Sufentanil is superior to fentanyl, as it facilitates the spread of the block and offers greater postoperative analgesic efficacy.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2009.

Kim SY, Cho JE, Hong JY, et al. Comparison of intrathecal fentanyl and sufentanil in low-dose dilute bupivacaine spinal anaesthesia for transurethral prostatectomy. Br J Anaesth 2009; 103: 750–754

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