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PAIN MEDICINE

Spinal Mechanisms Contribute to Analgesia Produced by Epidural Sufentanil Combined with Bupivacaine for Postoperative Analgesia

Jean L. Joris, MD PhD^*, Eric A. Jacob, MD^*, Daniel I. Sessler, MD, Jean-François J. Deleuse, MD^*, Abdourahamane Kaba, MD^*, and Maurice L. Lamy, MD^*

*Department of Anesthesia and Intensive Care Medicine and the Outcomes Research® Institute and Department of Anesthesiology, University of Louisville, Louisville, Kentucky

Address correspondence to Jean L. Joris, MD, PhD, Department of Anesthesia and Intensive Care Medicine, CHU de Liège, Domaine du Sart-Tilman, B-4000 Liège, Belgium. Address e-mail to Jean. Joris{at}chu.ulg.ac.be Reprints will not be available from the author.

When used alone, lipid-soluble epidural opioids are thought to produce analgesia supraspinally via systemic absorption. However, spinal opioids and local anesthetics have been shown to act synergistically at the spinal level in animal studies. We, therefore, tested the hypothesis that sufentanil requirements will be less when given epidurally than IV in patients simultaneously given epidural bupivacaine after major abdominal surgery. Forty patients were anesthetized with isoflurane and epidural bupivacaine for major abdominal surgery. After surgery, each was given a continuous epidural infusion of bupivacaine at a rate of 5 mg/h and sufentanil patient-controlled analgesia (PCA). In a randomized, double-blinded fashion, the sufentanil was given either epidurally or IV. PCA settings were the same in each group. For 60 hrs after surgery, the following variables were measured: pain scores at rest, during mobilization, and during coughing; extension of sensory block; side effects; and sufentanil consumption. Pain scores, extension of sensory block, and the incidence of side effects did not differ between the two groups. Consumption of sufentanil in the epidural group was half that of the IV group (48 h after surgery: 107 ± 57 µg versus 207 ± 100 µg for the epidural and IV groups, respectively; P < 0.05). We conclude that spinal mechanisms contribute to the analgesia produced by epidural sufentanil in combination with a local anesthetic.

IMPLICATIONS: When combined with epidural bupivacaine, the sufentanil requirement was 50% less when given epidurally than IV. Epidural sufentanil thus appears to have a spinal mechanism of action.

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