Adding sufentanil to ropivacaine in continuous thoracic paravertebral block fails to improve analgesia after video-assisted thoracic surgery: A randomised controlled trial

摘要

BACKGROUNDThe benefit of adding opioid to a local anaesthetic for continuous thoracic paravertebral analgesia after video-assisted thoracic surgery (VATS) is unclear.OBJECTIVESTo analyse the analgesic efficacy of ropivacaine and sufentanil in combination compared with ropivacaine alone after VATS.DESIGNA randomised, double-blinded, single-centre clinical trial.SETTINGA tertiary university hospital between March 2010 and April 2014.PATIENTSNinety patients were recruited, two were not included leaving 88 randomised into two groups. Eighteen patients were excluded from analysis and 70 completed the study.INTERVENTIONTo receive thoracic paravertebral analgesia with either 2mgml(-1) ropivacaine and 0.25gml(-1) sufentanil (ropivacaine+sufentanil group) or 2mgml(-1) ropivacaine alone (ropivacaine group) for 48h postoperatively. Infusion rate was set at 0.15mlkg(-1)h(-1) in both groups.MAIN OUTCOME MEASURESThe primary endpoint was the mean total amount of self-administered morphine by the patients in each group at 48h postoperatively.RESULTSThe mean SD total amount of self-administered morphine was not significantly different between groups (53.127.2mg in the ropivacaine+sufentanil group vs. 58.8 +/- 34.3mg in the ropivacaine group; P=0.72). No significant differences were found between the two groups in either pain scores at rest or during movement, in opioid-related adverse reactions, in patient satisfaction or length of hospital stay.CONCLUSIONAdding 0.25gml(-1) sufentanil to 2mgml(-1) ropivacaine in continuous thoracic paravertebral analgesia for VATS did not reduce morphine consumption or pain scores when compared with ropivacaine alone. We cannot recommend its use for routine clinical practice. Further studies analysing different concentrations and infusion rates of sufentanil are needed before a lack of efficacy can be confirmed.TRIAL REGISTRATIONClinical trial registrations: EudraCT: 2009-014832-38. ClinicalTrials.gov: NCT 01082744.