Yonsei Med J.  2015 May;56(3):832-837. 10.3349/ymj.2015.56.3.832.

Sparing Effects of Sufentanil on Epidural Ropivacaine in Elderly Patients Undergoing Transurethral Resection of Prostate Surgery

• Li H
• Li Y
• He R

• KMID: 2450361
• DOI: http://doi.org/10.3349/ymj.2015.56.3.832

Abstract

PURPOSE
This study examined the sparing effect of sufentanil on the median effective concentration (EC50) of epidural ropivacaine in elderly patients undergoing elective transurethral resection of prostate (TURP).
MATERIALS AND METHODS
This was a prospective randomized double-blind dose-response study. Fifty eight elderly patients with American Society of Anesthesiologists physical status I-II who were scheduled for TURP surgery under epidural anesthesia were randomly allocated to a group receiving 15 mL of ropivacaine (group R) or a group receiving ropivacaine plus 5 microg of sufentanil (group RS). The concentration of ropivacaine was determined by a Dixon's up-and-down sequential allocation. The first participant received 0.3% of ropivacaine in both groups and subsequent concentrations were determined by the response of the previous patient in the same group. The EC50 of epidural ropivacaine was analyzed using the Dixon and Massey method.
RESULTS
The EC50 of ropivacaine during TURP surgery was 0.186% (95% confidence interval, 0.173-0.200%) in group R, and 0.136% (95% confidence interval, 0.127-0.144%) in group RS (p<0.01). No differences in Bromage scale of motor block examination and the onset time of sensory block were observed.
CONCLUSION
Administration of 5 microg of epidural sufentanil caused a 37% reduction in the EC50 of epidural ropivacaine in elderly patients who underwent TURP surgery. Thus, sufentanil addition during surgery of TURP can decrease the dose of ropivacaine anesthesia required.

Keyword

Ropivacaine; sufentanil; elderly patients

MeSH Terms

Aged
Aged, 80 and over
Amides/*administration & dosage
Anesthesia, Epidural/*methods
Anesthetics, Local/*administration & dosage
Dose-Response Relationship, Drug
Double-Blind Method
Humans
Male
Middle Aged
Pain Measurement
Prospective Studies
Sufentanil/*administration & dosage
*Transurethral Resection of Prostate
Treatment Outcome
Amides
Anesthetics, Local
Sufentanil

Figure

• 

  Fig. 1 The median effective concentration (EC50) of epidural ropivacaine for transurethral resection of prostate surgery is 0.186% (95% confidence interval, 0.173-0.200%) determined by the formula of Dixon and Massy. The testing interval was 0.025% (w/v). The vertical bar shows the concentration of ropivacaine (% w/v), and the horizontal bar shows the consecutive number of patients. w/v, weight/volume.

• 

  Fig. 2 The median effective concentration (EC50) of epidural ropivacaine with 5 µg of sufentanil for transurethral resection of prostate surgery is 0.136% (95% confidence interval, 0.127-0.144%) determined by the formula of Dixon and Massy. The testing interval was 0.025% (w/v). The vertical bar shows the concentration of ropivacaine (% w/v), and the horizontal bar shows the consecutive number of patients. w/v, weight/volume.

• 

  Fig. 3 Hemodynamic changes before (0 minutes) and after epidural injection. Values are mean (SD). There was no significant difference between group R and group RS. MAP, mean arterial blood pressure; HR, heart rate.

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