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Reduced Sufentanil Doses are Effective for Postoperative Analgesia After Ductal Closure in Extremely Premature Infants: A 10 Years Retrospective Cohort Study.

Soreze, Yohan MD; Audureau, Etienne MD, PhD; Decobert, Fabrice MD; Jaby, Olivier MD; Blary, Sabine MD; Danan, Claude MD; Durrmeyer, Xavier MD, PhD
Clinical Journal of Pain: Post Acceptance: March 21, 2017
doi: 10.1097/AJP.0000000000000487
Original Article: PDF Only

Objectives: The objective of the study was to assess the efficacy of reduced sufentanil doses for postoperative analgesia following surgical ductal closure in extremely premature infants.

Methods: This was a retrospective, single-center, cohort study comparing 2 sufentanil dosing regimens used between 2001 and 2010 and included all infants born at <28 weeks of gestation with surgical ductal closure. Sufentanil doses were reduced in 2007 as a standard of care. Time was divided into 3 epochs to distinguish the effects of practice changes over time from the effects of sufentanil dose change: epoch 1 (2001 to 2004), epoch 2 (May 2005 to 2007), and epoch 3 (June 2007 to 2010).

Results: A total of 109 of 114 eligible infants were analyzed (mean [+/-SD], gestational age: 25.1 [+/-1.1] wk; mean [+/-SD], birth weight: 756 [+/-144] g). Median sufentanil doses were significantly higher during epochs 1 and 2 (0.1 to 0.2 [micro]g/kg/h) than during epoch 3 (0.03 to 0.04 [micro]g/kg/h) (P<0.0001). EDIN (Echelle de Douleur et d'Inconfort du Nouveau-ne) pain scores were mostly <=4 throughout the study period and their changes over time were not contemporaneous with the reduction in sufentanil doses; they were lower during epoch 1 versus epochs 2 and 3 (P<0.0001) and comparable between epochs 2 and 3. Midazolam doses and paracetamol use were not higher during epoch 3 as compared with epochs 1 and 2. No difference in opioid-related adverse events was observed between the 3 epochs.

Conclusion: Our study supports the use of low continuous intravenous sufentanil doses, consistent with morphine doses currently recommended in this population.

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