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Fentanyl versus sufentanil: plasma concentrations during continuous epidural postoperative infusion in children
C Lejus1, D Schwoerer, I Furic
1Department of Anaesthesiology, Hôtel-Dieu, CHR Nantes, France.
Insights
This study measured plasma concentrations of fentanyl and sufentanil in children receiving epidural administration. Maximum drug levels were achieved quickly after loading doses and remained stable during continuous infusion.
Area of Science:
- Pediatric Anesthesiology
- Pharmacokinetics
- Pain Management
Background:
- Limited pharmacokinetic data exists for epidural fentanyl and sufentanil in pediatric patients.
- Epidural analgesia is crucial for post-operative pain management in children.
Purpose of the Study:
- To determine plasma concentrations of fentanyl and sufentanil during epidural administration in children.
- To evaluate the pharmacokinetics of epidural opioids in pediatric surgical patients.
Main Methods:
- Double-blind randomized study involving 12 children aged 5-12 years.
- Administration of epidural loading doses and continuous infusions of fentanyl or sufentanil with bupivacaine.
- Utilized an epidural patient-controlled analgesia (PCA) system for bolus doses.
Main Results:
- Maximal median plasma concentrations for fentanyl ranged from 0.117-0.247 ng/mL.
- Maximal median plasma concentrations for sufentanil ranged from 0.027-0.074 ng/mL.
- Peak drug levels were reached approximately 30 minutes (fentanyl) and 20 minutes (sufentanil) after loading doses, remaining stable over 48 hours.
Conclusions:
- Epidural fentanyl and sufentanil achieve predictable plasma concentrations in children during continuous infusion and PCA.
- The findings provide essential pharmacokinetic data for optimizing epidural opioid analgesia in pediatric populations.
Abstract:
No pharmacokinetic data are available with respect to the plasma concentrations and fentanyl or sufentanil during epidural administration in children. This double-blind randomized study included 12 children (5-12 yr). Patients in group F were given an epidural loading dose of fentanyl 1.5 micrograms kg-1 and in group S sufentanil 0.6 microgram kg-1. Both groups then received a continuous epidural infusion of bupivacaine 5 mg kg-1 day-1 with either fentanyl 5 micrograms kg-1 day-1 or sufentanil 2 micrograms kg-1 day-1. An epidural PCA system was also given to the children (bolus: bupivacaine 0.2 mg kg-1 and fentanyl 0.2 microgram kg-1 or sufentanil 0.08 microgram kg-1). Maximal median concentrations of plasma (0.117-0.247 ng ml-1 for fentanyl and 0.027-0.074 ng ml-1 for sufentanil) were reached approximately 30 and 20 min respectively after the loading doses. These values were similar to those measured after 48 h.