Anesth Pain Med.  2023 Oct;18(4):376-381. 10.17085/apm.23007.

Comparison of the effects of intraoperative remifentanil and sufentanil infusion on postoperative pain management in robotic gynecological surgery: a retrospective cohort study

• Sung TY
• Jee YS
• Cho SA
• Huh I
• Lee SJ
• Cho CK

• KMID: 2550917
• DOI: http://doi.org/10.17085/apm.23007

Abstract

Background
Remifentanil and sufentanil are potent short-acting synthetic opioid analgesics. The administration of remifentanil has been associated with the incidence of opioid-induced hyperalgesia. Opioid-induced hyperalgesia may be alleviated when opioids, such as morphine, are switched to sufentanil. Therefore, this retrospective observational study aimed to compare the effects of remifentanil and sufentanil on postoperative pain in patients undergoing robotic gynecological surgery. Methods: We retrospectively analyzed the electronic medical records of patients who underwent elective robotic gynecological surgery between January 2016 and February 2021. The patients were classified into sufentanil (n = 159) or remifentanil (n = 359) groups according to the opioids administered continuously during anesthesia. The primary outcome assessed in this study was the postoperative pain score measured using the numeric rating scale (NRS). The secondary outcomes assessed included the recovery time (from discontinuation of opioid infusion to extubation) and frequency of rescue analgesic administration in the post-anesthesia care unit (PACU). Results: The recovery time did not differ significantly between the two groups. The NRS score for pain (median [1Q, 3Q]) in the PACU was significantly lower in the sufentanil group than in the remifentanil group (2 [2, 3] vs. 4 [3, 7], P < 0.001). The frequency of rescue analgesic administration in the PACU was 6.3% and 35.4% in the sufentanil and remifentanil groups, respectively (P < 0.001). Conclusions: Sufentanil, as an adjunct to sevoflurane anesthesia is more advantageous than remifentanil in terms of postoperative pain control during robotic gynecological surgery.

Keyword

Gynecologic surgical procedures; Pain measurement; Remifentanil; Sufentanil

Figure

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  Fig. 1. Flow diagram of the study.

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  Fig. 2. Changes in the mean blood pressure during anesthesia. pre-op: pre-operation.

Reference

1. Becker DE, Rosenberg M. Nitrous oxide and the inhalation anesthetics. Anesth Prog. 2008; 55:124–30.

2. Falcone T. Introduction: Robot-assisted laparoscopic surgery. Fertil Steril. 2014; 102:909–10.

3. Mandel JE. Considerations for the use of short-acting opioids in general anesthesia. J Clin Anesth. 2014; 26(1 Suppl):S1–7.

4. Gustorff B, Nahlik G, Hoerauf KH, Kress HG. The absence of acute tolerance during remifentanil infusion in volunteers. Anesth Analg. 2002; 94:1223–8.

5. Lahtinen P, Kokki H, Hynynen M. Remifentanil infusion does not induce opioid tolerance after cardiac surgery. J Cardiothorac Vasc Anesth. 2008; 22:225–9.

6. Vinik HR, Kissin I. Rapid development of tolerance to analgesia during remifentanil infusion in humans. Anesth Analg. 1998; 86:1307–11.

7. Rauf K, Vohra A, Fernandez-Jimenez P, O'Keeffe N, Forrest M. Remifentanil infusion in association with fentanyl-propofol anaesthesia in patients undergoing cardiac surgery: effects on morphine requirement and postoperative analgesia. Br J Anaesth. 2005; 95:611–5.

8. Guignard B, Bossard AE, Coste C, Sessler DI, Lebrault C, Alfonsi P, et al. Acute opioid tolerance: intraoperative remifentanil increases postoperative pain and morphine requirement. Anesthesiology. 2000; 93:409–17.

9. Schmidt S, Bethge C, Förster MH, Schäfer M. Enhanced postoperative sensitivity to painful pressure stimulation after intraoperative high dose remifentanil in patients without significant surgical site pain. Clin J Pain. 2007; 23:605–11.

10. Shin SW, Cho AR, Lee HJ, Kim HJ, Byeon GJ, Yoon JW, et al. Maintenance anaesthetics during remifentanil-based anaesthesia might affect postoperative pain control after breast cancer surgery. Br J Anaesth. 2010; 105:661–7.

11. Yeom JH, Kim KH, Chon MS, Byun JW, Cho SY. Remifentanil used as adjuvant in general anesthesia for spinal fusion does not exhibit acute opioid tolerance. Korean J Anesthesiol. 2012; 63:103–7.

12. Glass PSA, Gan TJ, Howell S. A review of the pharmacokinetics and pharmacodynamics of remifentanil. Anesth Analg. 1999; 89(4 Suppl):S7.

13. Angst MS, Clark JD. Opioid-induced hyperalgesia: a qualitative systematic review. Anesthesiology. 2006; 104:570–87.

14. Derrode N, Lebrun F, Levron JC, Chauvin M, Debaene B. Influence of peroperative opioid on postoperative pain after major abdominal surgery: sufentanil TCI versus remifentanil TCI. A randomized, controlled study. Br J Anaesth. 2003; 91:842–9.

15. Mei W, Seeling M, Franck M, Radtke F, Brantner B, Wernecke KD, et al. Independent risk factors for postoperative pain in need of intervention early after awakening from general anaesthesia. Eur J Pain. 2010; 14:149. e1-7.

16. Glass PSA, Gan TJ, Howell S. A review of the pharmacokinetics and pharmacodynamics of remifentanil. Anesth Analg. 1999; 89(4 Suppl):7.

17. Liu YH, Hu XB, Yang XM, Wang YW, Deng M. Comparing remifentanil and sufentanil in stress reduction during neurosurgery: a randomised controlled trial. Int J Clin Pharm. 2020; 42:1326–34.

18. Engoren M, Luther G, Fenn-Buderer N. A comparison of fentanyl, sufentanil, and remifentanil for fast-track cardiac anesthesia. Anesth Analg. 2001; 93:859–64.

19. Damen SL, Nieuwenhuijs VB, Joosten W, Houweling PL, Clevers GJ. The effects of remifentanil and sufentanil on the quality of recovery after day case laparoscopic cholecystectomy: a randomized blinded trial. J Laparoendosc Adv Surg Tech A. 2004; 14:87–92.

20. Gerlach K, Uhlig T, Hüppe M, Nowak G, Schmitz A, Saager L, et al. Remifentanil-propofol versus sufentanil-propofol anaesthesia for supratentorial craniotomy: a randomized trial. Eur J Anaesthesiol. 2003; 20:813–20.

21. Martorano PP, Aloj F, Baietta S, Fiorelli A, Munari M, Paccagnella F, et al. Sufentanil-propofol vs remifentanil-propofol during total intravenous anesthesia for neurosurgery. A multicentre study. Minerva Anestesiol. 2008; 74:233–43.

22. Casati A, Albertin A, Fanelli G, Deni F, Berti M, Danelli G, et al. A comparison of remifentanil and sufentanil as adjuvants during sevoflurane anesthesia with epidural analgesia for upper abdominal surgery: effects on postoperative recovery and respiratory function. Anesth Analg. 2000; 91:1269–73.

23. Egan TD, Lemmens HJ, Fiset P, Hermann DJ, Muir KT, Stanski DR, et al. The pharmacokinetics of the new short-acting opioid remifentanil (GI87084B) in healthy adult male volunteers. Anesthesiology. 1993; 79:881–92.