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ANESTHETIC PHARMACOLOGY

Large-Dose Intrathecal Sufentanil Prevents the Hormonal Stress Response During Major Abdominal Surgery: A Comparison with Intravenous Sufentanil in a Prospective Randomized Trial

Paul J. Borgdorff, MD^*, Traian I. Ionescu, MD PhD, Peter L. Houweling, MD PhD^*, and Johannes T. A. Knape, MD PhD

*Department of Anaesthesiology, Diakonessenhuis Hospital, Utrecht, The Netherlands; and Division for Perioperative and Emergency Medicine, University Medical Centre, Utrecht, The Netherlands

Address correspondence and reprint requests to Paul J. Borgdorff, MD, Diakonessenhuis Hospital, PO Box 80250, 3508 TG Utrecht, The Netherlands. Address e-mail to pborgdorff{at}diakhuis.nl

We studied the effect of large-dose intrathecal sufentanil (ITS) for major abdominal surgery on the hormonal stress response. Forty patients were randomly allocated to receive either IV sufentanil (IVS) or 150 µg of ITS as part of general anesthesia. In the IVS group, adrenocorticotropic hormone (ACTH) and cortisol concentrations were larger than baseline and the ITS group, 60 min after incision and at skin closure. Plasma concentrations of cortisol and ACTH were not different from baseline in the ITS group during surgery. Six hours after skin closure, cortisol concentrations were larger than baseline in both groups. Twenty-four and 48 h after skin closure, ACTH and cortisol values were similar between groups. Norepinephrine concentrations increased after surgery in both groups. Blood glucose levels increased in both groups during and after surgery. Pain scores and morphine consumption during the first 48 h after surgery were lower in the ITS group. The data show that large-dose ITS prevents the intraoperative hormonal stress response in comparison with balanced anesthesia. We speculate that this is due to the highly specific binding of sufentanil to spinal and supraspinal receptors. This technique improves postoperative analgesia when compared with balanced anesthesia.

IMPLICATIONS: This prospective, randomized trial demonstrates that large-dose intrathecal sufentanil (150 µg) as part of combined general and regional anesthesia prevents activation of the hormonal stress response during major abdominal surgery and improves postoperative analgesia in comparison with IV balanced anesthesia.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999