Efficacy of sufentanil on block duration for chronic opium users for lower limb surgery

Study Type: Therapy
OE Level of Evidence: 2
Journal Level of Evidence: N/A
Synopsis
60 male patients, 30 with and 30 without opium addiction, who were scheduled to undergo lower limb orthopaedic surgery were randomized to receive spinal anesthesia (bupivacaine) with or without sufentanil. The purpose of this study was to compare the duration and onset times of sensory and motor blocks between four patient groups: patients with no history of opium addiction who were given placebo (1) or sufentanil (2) and chronic opium users who were given placebo (3) or sufentanil (4). Results demonstrated that Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Not Reported
Conflicts: None disclosed
CONTENT IS LOCKED
Why was this study needed now?
Recent evidence has demonstrated that satisfactory sensory and motor blockade time with spinal anesthesia may be significantly reduced in patients with chronic opioid use, which can represent a potential concern when these patients require orthopaedic procedures. It has been suggested that the addition of intrathecal sufentanil (potent opioid analgesic) to spinal anesthesia may increase blockade time for this patient population. Due to the lack of evidence investigating the efficacy of intrathecal sufentanil in patients with opium addiction, the current study was warranted and conducted.
What was the principal research question?
For patients who are chronic opium users undergoing lower-extremity orthopaedic surgery, did the addition of sufentanil to spinal anesthesia result in increased sensory and motor blockade time when compared to placebo and non-addict patients?
Population: 60 male patients (ASA class I and II), aged between 18 and 60, who were current smokers and scheduled for lower limb orthopaedic surgery, less than 2 hours in duration, under spinal anesthesia. Surgeries performed included those correcting femoral, ankle, and tibia/fibula fractures. Patients with addiction to any substance other than cigarettes or opioid drugs were excluded from participation. Opium addiction was defined as recurrent consumption (inhalation) of 1 to 2 mg of opium occurring daily for the last year without cessation (up until and including the day of surgery); opium use was assessed with an opiate urine test.
Intervention: Sufentanil group (non-addicts): patients with no history of opium addiction who received intrathecal administration of 5 mg/mL hyperbaric bupivacaine with 5 micrograms (1 mL) sufentanil (n=15; mean age= 35.7+/-8.3)). Sufentanil group (addicts): patients with opium addiction who received intrathecal administration of 5 mg/mL hyperbaric bupivacaine with 5 micrograms (1 mL) sufentanil (n=15; mean age= 36.8+/-5.8)
Comparison: Group 1: patients with no history of opium addiction who received intrathecal administration of 5 mg/mL hyperbaric bupivacaine and placebo (n=15; mean age= 34.4+/-10.8). Group 3: patients with opium addiction who received intrathecal administration of 5 mg/mL hyperbaric bupivacaine and placebo (n=15; mean age= 40.6+/-9.3).
Outcomes: The duration of sensory and motor blockades were the primary outcomes of this study; duration of sensory block was defined as the time between highest level of sensory block until regression of four segments; duration of motor block was defined as time between reaching full intensity motor blockade until recording of Bromage grade I score. Onset of sensory/motor blockades serves as the secondary outcomes; onset time of motor block was defined as the time between drug injection until achievement of Bromage grade IV score, whereas onset time of sensory block was defined as the time between drug administration until achievement of bilateral T8 sensory blockade.
Methods: RCT: patient- and assessor-blinded
Time: Outcomes were assessed immediately prior to patient operation.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.