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

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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.


PPT, PTO, and QPT at different time points in the exploratory study. PPT = pressure pain threshold, PTO = pressure pain tolerance, QPT = quantitative pricking pain threshold. Compared with T1, ∗P < 0.05; ∗∗P < 0.01; ∗∗∗P < 0.001.
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Figure 3: PPT, PTO, and QPT at different time points in the exploratory study. PPT = pressure pain threshold, PTO = pressure pain tolerance, QPT = quantitative pricking pain threshold. Compared with T1, ∗P < 0.05; ∗∗P < 0.01; ∗∗∗P < 0.001.

Mentions: Measurements of PPT, PTO, and QPT at the anterior superior iliac spine are shown in Table 5. A repeated ANOVA revealed significant differences at the various predetermined time points. All values increased at T2 and decreased at T3 versus T1, but LSD testing of multiple comparisons showed that some of these changes were not significant (P > 0.05; Fig. 3). However, at T4 and T5, all values were significantly lower in comparison with T1 (Table 5; Fig. 3). Pearson correlation analysis results for preoperative and postoperative percent change in PPT, PTO, and QPT are listed in Table 6. The percent change in QPT at T3, T4, and T5 compared with T1 showed a strong positive correlation with that at T2 (r2 = 0.814, 0.811, and 0.794, respectively; P < 0.001 for all).


To predict sufentanil requirement for postoperative pain control using a real-time method
PPT, PTO, and QPT at different time points in the exploratory study. PPT = pressure pain threshold, PTO = pressure pain tolerance, QPT = quantitative pricking pain threshold. Compared with T1, ∗P < 0.05; ∗∗P < 0.01; ∗∗∗P < 0.001.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: PPT, PTO, and QPT at different time points in the exploratory study. PPT = pressure pain threshold, PTO = pressure pain tolerance, QPT = quantitative pricking pain threshold. Compared with T1, ∗P < 0.05; ∗∗P < 0.01; ∗∗∗P < 0.001.
Mentions: Measurements of PPT, PTO, and QPT at the anterior superior iliac spine are shown in Table 5. A repeated ANOVA revealed significant differences at the various predetermined time points. All values increased at T2 and decreased at T3 versus T1, but LSD testing of multiple comparisons showed that some of these changes were not significant (P > 0.05; Fig. 3). However, at T4 and T5, all values were significantly lower in comparison with T1 (Table 5; Fig. 3). Pearson correlation analysis results for preoperative and postoperative percent change in PPT, PTO, and QPT are listed in Table 6. The percent change in QPT at T3, T4, and T5 compared with T1 showed a strong positive correlation with that at T2 (r2 = 0.814, 0.811, and 0.794, respectively; P < 0.001 for all).

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&#8202;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&#8202;&lt;&#8202;0.001) 5&#8202;minutes after sufentanil infusion, and the percent change in pricking pain threshold was positively associated with sufentanil requirement at 12 and 24&#8202;hours after surgery (&beta;&#8202;=&#8202;0.318, P&#8202;=&#8202;0.001; and &beta;&#8202;=&#8202;0.335, P&#8202;=&#8202;0.001). A receiver-operating characteristic curve analysis showed that patients with a change in pricking pain threshold &gt;188% were &gt;50% likely to require more sufentanil for postoperative pain control. In the exploratory study, experimental pain thresholds significantly decreased after the operation (P&#8202;&lt;&#8202;0.001), and we observed a positive correlation (P&#8202;&lt;&#8202;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.