Epidural sufentanil

Connelly NR, Parker RK, Vallurupalli V, Bhopatkar S, Dunn S. Comparison of epidural fentanyl versus epidural sufentanil for analgesia in ambulatory patients in early labor. Anesth Analg 2000 91(2) 374-8. 

Markedly lipid-soluble opioids have also been reported to cause respiratory depression. There was profound respiratory depression 100 minutes after the administration of fentanyl 100 micrograms epidurally (138), whilst epidural sufentanil caused apnea within a couple of minutes, reversed by nalbuphine (139). Epidural buprenorphine 150 micrograms produced prolonged time-dependent biphasic depression of carbon dioxide response in six healthy volunteers. The second maximum occurred at 8-10 hours after injection (140). Similar cases have been reported by others. 

Cheng EY, May J. Nalbuphine reversal of respiratory depression after epidural sufentanil. Crit Care Med 1989 17(4) 378-9. 

In another randomized, double-blind study in 40 primi-parous women in labor at less than 5 cm cervical dilatation who requested epidural analgesia, the addition of clonidine 75 micrograms to epidural sufentanil 20 micrograms did not provide any advantages in analgesic efficacy or adverse effects (7). 

When epidural sufentanil is used for labor and delivery, the neonates can have subtle neurological signs of drug depression, including mild hypotonia, poor primary reflexes, and poor habituation to repeated stimuli at 1 and 4 hours of life (SEDA-16, 86). 

Akural El, Salomaki TE, Tekay AH, Bloigu AH, Alahuhta SM. Pre-emptive effect of epidural sufentanil in abdominal hysterectomy. Br J Anaesth 2002 88(6) 803-8. 

Connelly NR, Mainkar T, El-Mansouri M, Manikantan P, Venkata RR, Dunn S, Parker RK. Effect of epidural cloni-dine added to epidural sufentanil for labor pain management. Int J Obstet Anesth 2000 9(2) 94-8. 

Armstrong KP, Kennedy B, Watson JT, Morley-Forster PK, Yee I, Butler R. Epinephrine reduces the sedative side effects of epidural sufentanil for labour analgesia. Can J Anaesth 2002 49(l) 72-80. 

Sufentanil (as other opioids) given epidurally can produce analgesia one of three ways. It can spread cephalad in the CSF to supraspinal centers, be absorbed systemically and transfer to supraspinal centers, or act directly in the dorsal horn of the spinal cord on the spinal opioid receptors. It is felt that the main site of action of epidural sufentanil is pre-synaptic modulation of the nociceptive signal in the lamina of Rexed in the spinal cord. Sufentanil has a... 

D uration of action of epidural sufentanil is between that of fentanyl and morphine, usually between 2 and 4 hours. Once systemically absorbed it is metabohzed by the liver and excreted by the kidney. 

In the 1970s sufentanil was first introduced as a new potent opioid for use in anesthesia. The use of this drug was originally recommended for intravenous peri-operative analgesia. In the following years other uses for this opioid were explored, such as intrathecal and epidural use for peri-operative analgesia, labor and delivery, and chronic pain. Although epidural sufentanil is only FDA-approved for use in labor and delivery, studies have found it to be an acceptable option in other clinical situations. 

The addition of epidural sufentanil to local anesthetics significantly potentiates their analgesic effects. They also provide for safe and effective analgesia at a lower concentration and dose of local anesthetics. As a result this decreases the incidence of side effects such as motor blockade and hypotension. 

Epidural sufentanil is not typically used for neuropathic pain. 

Joris JL, Jacob EA, Sessler DI. Spinal mechanisms contribute to analgesia proceduced by epidural sufentanil combined with bupivacaine for postoperative analgesia. Anesth Analg 2003 97(5) 1446-1451. 

Comparative studies In a comparison of epidural sufentanil 0.015 micrograms/kg and fentanyl 0.1 micrograms/kg in children undergoing urological surgery, the former was associated with a higher incidence of pruritus (in six out of 32 compared with none) [170 ]. 

Cho JE, Kim JY, Kim JE, Chun DH, Jun NH, Kil HK. Epidural sufentanil provides better analgesia from 24 h after surgery compared with epidural fentanyl in children. Acta Anaesthesiol Scand 2008 52(10) 1360-3. 

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