Pharmacokinetics of Sufentanil After Epidural Administration
Condition: Epidural; Anesthesia; Epidural Analgesia; Abdominal Surgery
Study type: Observational

Summary: 
      Sufentanil is an opioid analgesics used in all groups of patients. It has one of the
      strongest effects among analgesic drugs. Sufentanil is widely-used because of its very quick
      onset, short duration of action, and better hemodynamic stability in patients compared to
      other opioids. Most of the pharmacokinetic studies described intravenous administration of
      sufentanil. The drug can also be epidural administrated (especially continuous epidural
      infusion) in low concentration with local anesthetics (ropivacaine or bupivacaine) for
      epidural analgesia. Epidural analgesia offers effective pain relief not only during the
      surgery, but also postoperatively. The combination of two drugs provides their additive
      effect and can reduce doses required for pain relief, then decreases the number and severity
      of adverse events. The study aims to describe the pharmacokinetics of epidural sufentanil
      used perioperative in adult patients after abdominal surgery to adjust the dosage if
      necessary.
    

Detailed description: 
      The patients qualified for abdominal surgery were enrolled in the study. All patients were
      premedicated with oral midazolam (7.5 mg). Epidural cannulations were placed by
      anesthesiologists before general anesthesia. The catheters' placement procedure was conducted
      under local anesthesia and according to the local protocol for the infections' prevention.
      The epidural infusion (solution of 0.2 % ropivacaine 5 ml with 25 to 50 mcg sufentanil in 50
      ml of 0,9% NaCl) was started with a 5 mL bolus of the mentioned solution a few minutes before
      skin incision. The continuous infusion was maintained throughout the surgery at the rate of
      3-12 mL/h. The patients were induced into general endotracheal anesthesia according to a
      standardized protocol, with propofol 1-3 mg/kg, fentanyl 1-2 mcg/kg, and rocuronium bromide
      0.6 mg/kg. Anaesthesia was continued by using sevoflurane or desflurane MAC 1 to maintain
      mean arterial pressure with a value of +/- 20% of the original value. The postoperatively
      patients were monitored in the PACU (Post Anesthesia Care Unit) for 1 hour and then
      transferred to the intensive care unit or surgical unit according to their clinical status
      and co-morbidities. Whole blood samples (2.0 ml) were collected to measure sufentanil
      concentrations - during the epidural infusion and up to 72 hours after its cessation. Vital
      parameters (e.g. blood pressure, saturation, heart rate, respiratory rate, and pain score)
      were monitored at regular intervals. The epidural sufentanil and ropivacaine infusion were
      continued after surgery as long as was necessary.
    

Intervention name(s): Epidural administration of sufentanil
Intervention type(s): Drug
Intervention description(s): The epidural cannulations were placed by anesthesiologists before general anesthesia. Correct positioning of the catheters were tested and confirmed by negative aspiration and injection of 3 mL of 2% Lidocaine. The epidural infusion (solution of 0.2 % ropivacaine 5 ml with 25 to 50 mcg sufentanil in 50 ml of 0,9% NaCl) was started with bolus of 5 ml over 5 minutes and then continuous infusion was maintained was throughout the surgery at 3-12 mL/h and 2-12 mL/h after the surgery. Single dose of sufentanil was given when needed.
Other intervention name(s): Continuous epidural infusion of sufentanil
Intervention MeSH terms: Sufentanil; Dsuvia
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        The adult patients qualified to abdominal surgery performed in epidural anesthesia using
        sufentanil.
      
Keywords: abdominal surgery; epidural analgesia; epidural anesthesia; pharmacokinetics; surgery patients; sufentanil