par Wilwerth, Mauricio Wolf M.;Majcher, Jean-Louis ;Van Der Linden, Philippe
Référence Acta anaesthesiologica Scandinavica, 60, 9, page (1306-1313)
Publication Publié, 2016
Article révisé par les pairs
Résumé : Background: Fentanyl and sufentanil are the most commonly administered intrathecal lipophilic opioids worldwide, although their relative efficacy when given by this route is not well characterised. The primary endpoint of this prospective, randomised, double-blind study was to compare effective analgesia duration of intrathecal administered fentanyl 25 μg and sufentanil 2.5 or 5 μg, Second endpoints were to compare post-operative morphine consumption and incidence of side effects between these opioids dosages. Methods: After IRB approval, 180 full-term parturients undergoing elective Caesarean section were randomly allocated into three groups, according to the opioid added to 10 mg intrathecal hyperbaric bupivacaine: fentanyl 25 μg, sufentanil 2.5 μg or sufentanil 5 μg. Total effective analgesia was defined as time from spinal injection (T0) to first IV morphine requirement (T1) administered with a patient controlled intravenous pump. Statistical data analysis included non-parametric tests and chi-squared. A P value < 0.05 was considered statistically significant. Data are presented as median [interquartile ranges 25–75]. Results: Duration of analgesia was significantly longer with sufentanil 2.5 μg (214 min [189–251]) and 5 μg (236 min [190–372]) compared to fentanyl 25 μg (187 min [151–230]) (P < 0.01). Morphine consumption at T1 + 4 h was lower in the sufentanil groups (6 mg [3–9] and 6 mg [2–10]) than in the fentanyl group (9 mg [5–13]) (P < 0.01). Incidence of adverse effects was not different between groups. Conclusion: In the conditions of our study, sufentanil 5 μg was the opioid of choice, associated with the best quality of anaesthesia without increased incidence of side effects.

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