Comparison of fentanyl, sufentanil and alfentanil during awake craniotomy for epilepsy

Neurolept anaesthesia is used during awake craniotomy for epilepsy surgery. This study compares analgesia, sedation and the side effects of the newer opioids sufentanil and alfentanil, with those of fentanyl in patients undergoing awake craniotomy. Thirty patients were randomized into three groups, each received droperidol, dimenhydrinate and the chosen opioid as a bolus followed by an infusion. The opioid doses used were fentanyl 0.75 microgram.kg-1 plus 0.01 microgram.kg-1 x min-1; sufentanil 0.075 microgram.kg-1 plus 0.0015 microgram.kg-1 x min-1, and alfentanil 7.5 micrograms.kg-1 plus 0.5 microgram.kg-1 x min-1. There were no differences in the requirements for droperidol, dimenhydrinate or in the incidence of complications among the three groups. The total doses of the opioids required were fentanyl 4.9 +/- 1.3 micrograms.kg-1, sufentanil 0.6 +/- 0.2 microgram.kg-1 and alfentanil 149 +/- 36 micrograms.kg-1. Two patients became uncooperative requiring general anesthesia. The conditions for surgery, electrocorticography and for stimulation testing were satisfactory in all other patients. We conclude that the newer opioids did not offer any benefit over fentanyl.