Limits...
To predict sufentanil requirement for postoperative pain control using a real-time method

View Article: PubMed Central - PubMed

ABSTRACT

Preoperative identification of individual sensitivity to opioid analgesics could improve the quality of postoperative analgesia. We explored the feasibility and utility of a real-time assessment of sufentanil sensitivity in predicting postoperative analgesic requirement.

Our primary study included 111 patients who underwent measurements of pressure and quantitative pricking pain thresholds before and 5 minutes after sufentanil infusion. Pain intensity was assessed during the first 24-hour postsurgery, and patients who reported inadequate levels of analgesia were excluded from the study. The sufentanil requirement for patient-controlled analgesia was recorded, and a subsequent exploratory study of 20 patients facilitated the interpretation of the primary study results. In the primary study, experimental pain thresholds increased (P < 0.001) 5 minutes after sufentanil infusion, and the percent change in pricking pain threshold was positively associated with sufentanil requirement at 12 and 24 hours after surgery (β = 0.318, P = 0.001; and β = 0.335, P = 0.001). A receiver-operating characteristic curve analysis showed that patients with a change in pricking pain threshold >188% were >50% likely to require more sufentanil for postoperative pain control. In the exploratory study, experimental pain thresholds significantly decreased after the operation (P < 0.001), and we observed a positive correlation (P < 0.001) between the percent change in pricking pain threshold before and after surgery. Preoperative detection of individual sensitivity to sufentanil via the above described real-time method was effective in predicting postoperative sufentanil requirement. Thus, percent change in pricking pain threshold might be a feasible predictive marker of postoperative analgesia requirement.

No MeSH data available.


Flow diagram of primary and exploratory sample enrollment. PPT = pressure pain threshold, PTO = pressure pain tolerance, QPT = quantitative pricking pain threshold.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4998318&req=5

Figure 1: Flow diagram of primary and exploratory sample enrollment. PPT = pressure pain threshold, PTO = pressure pain tolerance, QPT = quantitative pricking pain threshold.

Mentions: As shown in Fig. 1, 111 female patients (age 20–65 years) scheduled for gynecologic surgery under general anesthesia were recruited in the primary sample. The inclusion criteria were as follows: (1) voluntarily received postoperative patient-controlled analgesia (PCA); (2) right-hand dominance; and (3) grouping based on the American Society of Anesthesiologists physical status I to II. Exclusion criteria were as follows: (1) known history of chronic pain or use of any analgesic medication over the prior 4 weeks; (2) presence of dermatitis or damaged, red, or swelling skin at the selected test sites; and (3) preoxygenation pulse oxygen saturation that could not be maintained at 90% or above before induction of anesthesia. A subsequent exploratory sample of 20 patients, with the same inclusion and exclusion criteria as the primary sample, was recruited to aid in the interpretation of results from the primary study.


To predict sufentanil requirement for postoperative pain control using a real-time method
Flow diagram of primary and exploratory sample enrollment. PPT = pressure pain threshold, PTO = pressure pain tolerance, QPT = quantitative pricking pain threshold.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998318&req=5

Figure 1: Flow diagram of primary and exploratory sample enrollment. PPT = pressure pain threshold, PTO = pressure pain tolerance, QPT = quantitative pricking pain threshold.
Mentions: As shown in Fig. 1, 111 female patients (age 20–65 years) scheduled for gynecologic surgery under general anesthesia were recruited in the primary sample. The inclusion criteria were as follows: (1) voluntarily received postoperative patient-controlled analgesia (PCA); (2) right-hand dominance; and (3) grouping based on the American Society of Anesthesiologists physical status I to II. Exclusion criteria were as follows: (1) known history of chronic pain or use of any analgesic medication over the prior 4 weeks; (2) presence of dermatitis or damaged, red, or swelling skin at the selected test sites; and (3) preoxygenation pulse oxygen saturation that could not be maintained at 90% or above before induction of anesthesia. A subsequent exploratory sample of 20 patients, with the same inclusion and exclusion criteria as the primary sample, was recruited to aid in the interpretation of results from the primary study.

View Article: PubMed Central - PubMed

ABSTRACT

Preoperative identification of individual sensitivity to opioid analgesics could improve the quality of postoperative analgesia. We explored the feasibility and utility of a real-time assessment of sufentanil sensitivity in predicting postoperative analgesic requirement.

Our primary study included 111 patients who underwent measurements of pressure and quantitative pricking pain thresholds before and 5 minutes after sufentanil infusion. Pain intensity was assessed during the first 24-hour postsurgery, and patients who reported inadequate levels of analgesia were excluded from the study. The sufentanil requirement for patient-controlled analgesia was recorded, and a subsequent exploratory study of 20 patients facilitated the interpretation of the primary study results. In the primary study, experimental pain thresholds increased (P < 0.001) 5 minutes after sufentanil infusion, and the percent change in pricking pain threshold was positively associated with sufentanil requirement at 12 and 24 hours after surgery (β = 0.318, P = 0.001; and β = 0.335, P = 0.001). A receiver-operating characteristic curve analysis showed that patients with a change in pricking pain threshold >188% were >50% likely to require more sufentanil for postoperative pain control. In the exploratory study, experimental pain thresholds significantly decreased after the operation (P < 0.001), and we observed a positive correlation (P < 0.001) between the percent change in pricking pain threshold before and after surgery. Preoperative detection of individual sensitivity to sufentanil via the above described real-time method was effective in predicting postoperative sufentanil requirement. Thus, percent change in pricking pain threshold might be a feasible predictive marker of postoperative analgesia requirement.

No MeSH data available.