Comparison of morphine, meperidine, fentanyl, and sufentanil in balanced anesthesia: a double-blind study

A double-blind study comparing four narcotic analgesics of different potencies, meperidine, morphine, fentanyl, and sufentanil, was performed on consenting patients undergoing general or orthopedic surgery under balanced anesthesia. Blood pressure, measured through an indwelling arterial catheter, was recorded continuously, as were ECG and heart rates. The narcotics, made up in equipotent concentrations, were given as indicated by hemodynamic and clinical signs. Arterial blood samples were taken before and after induction, after intubation, before and after incision, at intervals during the operation, and postoperatively. Hemodynamic values and plasma levels of catecholamines during and after induction, intubation, incision, and throughout the operation were least in patients given sufentanil and greatest in those who received morphine or meperidine. Heart rates increased significantly after induction with meperidine and were significantly higher after intubation in morphine-treated and meperidine-treated patients than they were in patients receiving sufentanil. Intraoperatively, mean arterial blood pressure, rate-pressure product, and plasma norepinephrine levels were lowest in patients receiving sufentanil. Intraoperative plasma epinephrine levels were lowest in patients receiving sufentanil and meperidine. Because of increases in blood pressure, heart rate, or both to greater than 15% above control values, supplementation with a potent inhalational agent was necessary in 38%, 30%, and 29% of the patients given meperidine, morphine, and fentanyl, respectively. No sufentanil patient required supplementation. Side effects, including histamine release accompanied by tachycardia and hypotension, were most frequent and most severe in patients who received meperidine. After extubation, marked increases in heart rate, blood pressure, and plasma norepinephrine and epinephrine occurred in some patients in each group. The incidence of postoperative respiratory depression was greatest in patients given morphine (mean dose of naloxone 8.6 micrograms/kg) and least with sufentanil (mean dose of naloxone 1.8 micrograms/kg) and fentanyl (3.2 micrograms/kg naloxone).