Comparison of the recovery profile of sufentanil and remifentanil in total intravenous anesthesia: a systematic review and meta-analysis of randomized controlled trials
Comparação do perfil de recuperação de sufentanil e remifentanil em anestesia intravenosa total: uma revisão sistemática e meta-análise de ensaios clínicos randomizados
Igor Seror Cuiabano, Rafael Pagliaro Naves, Rodrigo Bouchabki de A. Diehl
Abstract
Introduction
Remifentanil is a short-acting opioid and can be administered during surgery without the risk of delayed postoperative recovery but concerns about hyperalgesia and the shortages of remifentanil lead anesthetists to consider long-acting opioids for Total Intravenous Anesthesia (TIVA). Sufentanil is a more potent opioid with a longer context-sensitive half-life but can promote good postoperative analgesia due to its residual effect. This meta-analysis aimed to compare the recovery profile of remifentanil and sufentanil for TIVA.
Methods
The search strategy was performed in PubMed, CENTRAL, and Web of Science for RCTs comparing sufentanil and remifentanil as part of TIVA in adults undergoing noncardiac surgery. Risk of bias and the quality of evidence were performed using RoB2 and GRADEpro, respectively. The primary outcome was time to tracheal extubation. Secondary analyses included postoperative analgesia, respiratory depression, and Postoperative Nausea and Vomiting (PONV).
Results
Sufentanil increases the time to extubate, MD = 4.29 min; 95% CI: 2.33 to 6.26; p = 0.001. It also reduces the need for postoperative rescue analgesia, logOR = -1.07; 95% CI: -1.62 to -0.52; p = 0.005. There were no significant differences between both opioids for PONV, logOR = 0.50; 95% CI: -0.10 to 1.10; p = 0.10 and respiratory depression, logOR = 1.21; 95% CI: -0.42 to 2.84; p = 0.15.
Conclusion
Sufentanil delays the time to tracheal extubation compared with remifentanil but is associated with a reduced need for postoperative rescue analgesia. No significant differences were observed between the two opioids in terms of postoperative respiratory depression or PONV.
Keywords
Resumo
Introdução
Remifentanil é um opioide de curta ação e pode ser administrado durante a cirurgia sem o risco de recuperação pós-operatória tardia, mas preocupações com hiperalgesia e a escassez de remifentanil levam os anestesistas a considerar opioides de longa ação para Anestesia Intravenosa Total (TIVA). Sufentanil é um opioide mais potente com uma meia-vida mais longa sensível ao contexto, mas pode promover boa analgesia pós-operatória devido ao seu efeito residual. Esta meta-análise teve como objetivo comparar o perfil de recuperação de remifentanil e sufentanil para TIVA.
Métodos
A estratégia de busca foi realizada no PubMed, CENTRAL e Web of Science para RCTs comparando sufentanil e remifentanil como parte de TIVA em adultos submetidos à cirurgia não cardíaca. O risco de viés e a qualidade da evidência foram realizados usando RoB2 e GRADEpro, respectivamente. O desfecho primário foi o tempo para extubação traqueal. As análises secundárias incluíram analgesia pós-operatória, depressão respiratória e náuseas e vômitos pós-operatórios (NVPO).
Resultados
O sufentanil aumenta o tempo para extubação, MD = 4,29 min; IC de 95%: 2,33 a 6,26; p = 0,001. Também reduz a necessidade de analgesia de resgate pós-operatória, logOR = -1,07; IC de 95%: -1,62 a -0,52; p = 0,005. Não houve diferenças significativas entre os dois opioides para NVPO, logOR = 0,50; IC de 95%: -0,10 a 1,10; p = 0,10 e depressão respiratória, logOR = 1,21; IC de 95%: -0,42 a 2,84; p = 0,15.
Conclusão
Sufentanil atrasa o tempo para extubação traqueal em comparação com remifentanil, mas está associado a uma necessidade reduzida de analgesia de resgate pós-operatória. Não foram observadas diferenças significativas entre os dois opioides em termos de depressão respiratória pós-operatória ou PONV.
Palavras-chave
References
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Submitted date:
02/21/2024
Accepted date:
08/15/2024
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