Patient-controlled analgesia with sulfentanyl and propofol sedation for burn dressing changes

Abstract

Abstract: AIM: To investigate the feasibility of patient-controlled analgesia with sulfentanyl and propofol sedation for burn dressing changes. METHODS: Sixty patients ASA Ⅰ-Ⅱ who had thermal burns of 20-50 percent total body surface area and were scheduled for burn dressing changes were randomly divided into three groups with twenty patients in each group. Each patient received an initial loading dose of i.v. sulfentanyl 0.25 μg/kg 5 min before the procedure, received target controlled infusion with propofol initial effect-site concentrations from 0.15 μg/kg at 2 min before the procedure. Adjusting the propofol effect-site concentrations to maintain BIS decline by 15-20 percent of baseline. The patients were allocated to receive on-demand analgesia with one of the three PCA-sulfentanyl demand doses-1, 3, and 5ug. The demand dose was delivered i.v. at a constant rate by a PCA pump with a 5-min lockout interval. Propofol and sulfentanyl comsumption, demands made per 10min,delivered per 10min and demand/delivery ratio were reorded, Pain intensity was assessed by the VAS score, Doctor and patents' satisfactories were asked. Incidence of postoperative nausea and vomiting, dizzy, respiratory depression and hypotension were recorded. RESULTS: Propofol comsumption in 5 μg group were significantly lower than those in 1 and 3 μg group(P<0.01, P<0.05), but higher in 1 μg group than those in 3 μg group(P<0.05). Total sulfentanyl comsumption dosage in 5 μg and 3μg group were significantly higher than those in the 1 μg group(P＜0.01). During the dressing change procedure, mean VAS scores, demands made per 10min, delivered per 10min and demand/delivery ratio in the sulfentanyl 1 μg groups were significantly higher than those in the 3 and 5 μg groups(P<0.01), and there are no difference between 3 μg group and 5 μg group(P>0.05). Patients and doctors' satisfactories were signicantly higher in 3 and 5 μg groups than those in 1 μg group(P＜0.01), while no difference between 3 μg group and 5 μg group(P>0.05). The incidence of dizzy were signicantly higher in 5 μg groups than those in 1 μg and 3 μg group(P<0.01, P<0.05). CONCLUSION: The optimal PCA-sulfentanyl demand dose in our study is 3 μg after an i.v. initial loading dose of 0.25 μg/kg and a lockout interval of 5 minutes, Combining with propofol for sedation is safety and feasible.

Key words: Sulfentanyl, Patient-controlled analgesia, Sedation, Burn dressing change

CLC Number:

R614

WANG Ming-cang, CHEN Ling-yang, LIN Xian-ju, CAO Dong-hang, XIANG Hai-fei. Patient-controlled analgesia with sulfentanyl and propofol sedation for burn dressing changes[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2010, 15(4): 449-453.

References

[1] Sim KM, Hwang NC, Chan YW, et al. Use of patient controlled analgesia with alfentanil for burns dressing procedures: a preliminary report of five patients[J]. Burns, 1996, 22(3):238-241.
[2] Coimbra C, Choinie M, Thomas M, et al. Patient-controlled sedation using propofol for dressing changes in burn patients: a dose-finding study[J].Anesth-Analg, 2003, 97(3):839-842.
[3] Hans P, Bonhomme V, Born JD, et al. Target-controlled infusion of propofol and remifentanil combined with bispectral index monitoring for awake craniotomy[J]. Anaesthesia, 2000, 55(3):255-259.
[4] Miller R, Eriksson L, Fleisher L, et al. Miller's Anesthesia (Seventh Edition )[M] .The United states of America: Natasha Andjelkovic, 2008:721-722.
[5] Tosun Z, Esmaoglu A, Coruh A. Propofol-ketamine vs propofol-fentanyl combinations for deep sedation and analgesia in pediatric patients undergoing burn dressing changes[J]. Pediatric Anesthesia, 2008,18(1):43-47.
[6] Choiniere M, Grenier R, Paquette C. Patient-controlled analgesia: a double-blind study in burn patients[J]. Anaesthesia, 1992,47(6):467-472.
[7] Badetti C, Bernini V, Pascal L, et al. Patient-controlled analgesia: a study of fentanyl requirements in burnt patients during the acute phase[J]. Ann Fr Anesth Reanim, 1994,13(6):789-797.
[8] Prakash S, Fatima T, Pawar M. Patient-controlled analgesia with fentanyl for burndressing changes[J]. Anesth Analg, 2004,99(2):552-555.
[9] Kalvass JC, Olson ER, Cassidy MP, et al. Pharmacokinetics and pharmacodynamics of seven opioids in P-glycoprotein-competent mice: assessment of unbound brain EC₅₀, u and correlation of in vitro, preclinical, and clinical data [J]. J Pharmacol Exp Ther ,2007,323(1):346-355.
[10] 金立达,蒋柳明,赵喜越,等.舒芬太尼复合异丙酚靶控输注全凭静脉麻醉用于神经外科手术的临床研究[J].中国临床药理学与治疗学,2009,14(5):572-576.