Lehmann K A, Gerhard A, Horrichs-Haermeyer G, Grond S, Zech D
Department of Anesthesiology and Operative Intensive Care, University of Cologne, FRG.
Acta Anaesthesiol Scand. 1991 Apr;35(3):221-6. doi: 10.1111/j.1399-6576.1991.tb03277.x.
Sufentanil has so far seldom been used for intravenous postoperative patient-controlled analgesia (PCA), and the resulting serum concentrations have not yet been determined. Forty ASA I-III patients recovering from major gynecological operations were investigated to evaluate analgesic efficacy, side effects, patient acceptance and threshold concentrations of sufentanil in serum during the early postoperative period, using the On-Demand Analgesia Computer (ODAC). Following an individualized intravenous loading dose of 19.1 +/- 35.7 micrograms (mean +/- 1 s.d.), sufentanil demand doses were 6 micrograms with a concurrent infusion of 1.15 micrograms/h and a maximum hourly dose of 40 micrograms/h; the lockout time was set to 1 min. The duration of PCA was 17.3 +/- 2.1 h. During this time 16 +/- 11 demands per patient were recorded, resulting in an average sufentanil consumption of 131.1 +/- 69.4 micrograms or 7.5 +/- 3.7 micrograms/h (including loading dose). analgesia was mostly judged good. Side effects were only of minor intensity. Sufentanil proved to be about 2.2 to 3.8 times as potent an analgesic as fentanyl when both analgesic effect and duration were considered. Minimum effective sufentanil serum concentration (MEC) as determined by radioimmunoassay varied greatly and could be best described by a log-normal distribution (range less than 0.01-0.56 ng/ml, median 0.024 ng/ml). Intraindividual MEC variability was slightly lower than intersubject variability (76.0 vs. 84.8%). It is concluded that sufentanil is suitable for postoperative PCA. To get into the therapeutic window for analgesia, a serum sufentanil concentration of more than 0.03 ng/ml seems to be necessary.
迄今为止，舒芬太尼很少用于静脉术后患者自控镇痛（PCA），其产生的血清浓度尚未确定。本研究对40例从大型妇科手术中恢复的ASA I-III级患者进行了调查，使用按需镇痛计算机（ODAC）评估术后早期舒芬太尼的镇痛效果、副作用、患者接受度及血清阈值浓度。在给予个体化静脉负荷剂量19.1±35.7微克（均值±1标准差）后，舒芬太尼的按需剂量为6微克，同时持续输注速率为1.15微克/小时，最大每小时剂量为40微克/小时；锁定时间设定为1分钟。PCA持续时间为17.3±2.1小时。在此期间，每位患者记录到16±11次需求，舒芬太尼平均消耗量为131.1±69.4微克或7.5±3.7微克/小时（包括负荷剂量）。镇痛效果大多判定为良好。副作用仅为轻度。当同时考虑镇痛效果和持续时间时，舒芬太尼的镇痛效力约为芬太尼的2.2至3.8倍。通过放射免疫测定法确定的最低有效舒芬太尼血清浓度（MEC）差异很大，最好用对数正态分布来描述（范围小于0.01 - 0.56纳克/毫升，中位数为0.024纳克/毫升）。个体内MEC变异性略低于个体间变异性（76.0%对84.8%）。结论是舒芬太尼适用于术后PCA。为进入镇痛治疗窗，血清舒芬太尼浓度似乎需要超过0.03纳克/毫升。
