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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.


A, Test locations 1 and 2 (each marked with an X) on the right forearm. B, Test locations 3 and4 on the anterior superior iliac spine.
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Figure 2: A, Test locations 1 and 2 (each marked with an X) on the right forearm. B, Test locations 3 and4 on the anterior superior iliac spine.

Mentions: Two test locations were selected on the right forearm for the stimulus-evoked pain tests (Fig. 2A).[18,20] The investigator applied the algometer for the pressure pain test at location 1, which corresponded to the lateral brachioradialis of the elbow joint. For the pricking pain test at location 2, the investigator applied the algometer to the midpoint of the medial and lateral borders of the wrist. A standardized procedure was used for all subjects, who were asked to say “pain” when they started to feel pain (PPT or QPT) during stimulation and “okay” when the pain became intolerable (PTO). This procedure was repeated 1 minute later, and the average of the 2 measurements was calculated.


To predict sufentanil requirement for postoperative pain control using a real-time method
A, Test locations 1 and 2 (each marked with an X) on the right forearm. B, Test locations 3 and4 on the anterior superior iliac spine.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: A, Test locations 1 and 2 (each marked with an X) on the right forearm. B, Test locations 3 and4 on the anterior superior iliac spine.
Mentions: Two test locations were selected on the right forearm for the stimulus-evoked pain tests (Fig. 2A).[18,20] The investigator applied the algometer for the pressure pain test at location 1, which corresponded to the lateral brachioradialis of the elbow joint. For the pricking pain test at location 2, the investigator applied the algometer to the midpoint of the medial and lateral borders of the wrist. A standardized procedure was used for all subjects, who were asked to say “pain” when they started to feel pain (PPT or QPT) during stimulation and “okay” when the pain became intolerable (PTO). This procedure was repeated 1 minute later, and the average of the 2 measurements was calculated.

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.