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Inflammation increases sufentanil requirements during surgery for inflammatory bowel diseases

Published online by Cambridge University Press:  11 July 2005

A. Guidat ,
M. Fleyfel ,
B. Vallet ,
P. Desreumaux ,
J. C. Levron ,
L. Gambiez ,
J. F. Colombel  and
P. Scherpereel
A. Guidat
Affiliation:
Hôpital Claude Huriez, Département d'Anesthésie Réanimation 2, CHU, Lille, France
M. Fleyfel
Affiliation:
Hôpital Claude Huriez, Département d'Anesthésie Réanimation 2, CHU, Lille, France
B. Vallet
Affiliation:
Hôpital Claude Huriez, Département d'Anesthésie Réanimation 2, CHU, Lille, France
P. Desreumaux
Affiliation:
Hôpital Claude Huriez, Département de Gastroentérologie, CHU, Lille, France
J. C. Levron
Affiliation:
Hôpital Claude Huriez, Janssen Research Foundation, Campus de Maigremont, Val de Reuil Cedex, France
L. Gambiez
Affiliation:
Hôpital Claude Huriez, Département Chirurgie Adulte, CHU, Lille, France
J. F. Colombel
Affiliation:
Hôpital Claude Huriez, Département de Gastroentérologie, CHU, Lille, France
P. Scherpereel
Affiliation:
Hôpital Claude Huriez, Département d'Anesthésie Réanimation 2, CHU, Lille, France
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Extract

Summary

Background and objective: Inflammation promotes hyperalgesia and increases opioid binding protein (α1-acid glycoprotein) inducing increased opioid requirement. To investigate the influence of an acute episode of inflammatory bowel disease in opioid requirement during major abdominal surgery, 17 patients with Crohn's disease, 12 patients with ulcerative colitis and seven patients without any inflammatory process (control group) were prospectively studied. Sufentanil requirements were assessed during surgery.

Methods: Sufentanil administration was adjusted when haemodynamic variables changed more than 20% of preoperative values. In a subgroup of 20 patients (Crohn's disease: 7, ulcerative colitis: 7, control group: 6), plasma concentrations of α1-acid glycoprotein and unbound sufentanil were measured. Total plasma clearance of sufentanil was also determined. Data presented as median (25–75‰) were analysed by non-parametric and ANOVA tests.

Results: Despite similar surgery duration, intraoperative sufentanil requirements were significantly larger in both the Crohn's disease group (0.9 (0.6–1.6) μg kg−1 h−1) and the ulcerative colitis group (1.1 (0.6–1.7) μg kg−1 h−1) than in the control group (0.5 (0.4–0.5) μg kg−1 h−1). Total plasma clearance of sufentanil was larger in patients with inflammatory bowel disease than in the control group. The plasma α1-acid glycoprotein concentration was increased in the inflammatory bowel disease group. However, the free fraction of sufentanil was similar in all three groups. The largest sufentanil consumption in patients with inflammatory bowel disease was observed during time of pain stimulation in the area of referred hyperalgesia from the affected viscus. In the control group, the sufentanil requirement was constant throughout surgery.

Conclusion: Inflammatory bowel disease increases opioid requirement during major abdominal surgery.

Keywords

ANAESTHESIA, GENERALanalgesics, opioids, sufentanilINTESTINAL DISEASES, inflammatory bowel disease, colitis, ulcerative, Crohn's diseasesomatosensory disorders, hyperalgesiasurgical procedures, operative, intraoperative period
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 20 , Issue 12 , December 2003 , pp. 957 - 962
Copyright
© 2003 European Society of Anaesthesiology

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References

Dray A. Inflammatory mediators of pain. Br J Anaesth 1995; 75: 125–131.Google Scholar
Levine J, Taiwo Y. Inflammatory pain. In: Wall PD, Melzack R, eds. Textbook of Pain, 4th edn. Edinburgh, UK: Churchill Livingstone, 1989: 45–56.
Maeyer EA, Gebhart GF. Basic and clinical aspects of visceral hyperalgesia. Gastroenterology 1994; 107: 271–293.Google Scholar
Petit SH, Holbroock IB, Irving MH. Comparison of clinical scores and acute phase proteins in the assessment of acute Crohn's disease. Br J Surgery 1985; 72: 1013–1016.Google Scholar
Weeke B, Jarnum S. Serum concentration of 19 serum proteins in Crohn's disease and ulcerative colitis. Gut 1971; 12: 297–302.Google Scholar
Gesink-van der Veer BJ, Burm AGL, Vletter AA, Bovill JG. Influence of Crohn's disease on the pharmacokinetics and pharmacodynamics of alfentanil. Br J Anaesth 1993; 71: 827–834.Google Scholar
Best WR, Becktel JM, Singleton JW, Kern Jr F. Development of a Crohn's disease activity index. National Cooperative Crohn's Disease Study. Gastroenterology 1976; 70: 439–444.Google Scholar
Edwards RC, Truelove SC. The course and prognosis of ulcerative colitis. Parts I and II: Short term and long term prognosis. Gut 1963; 4: 299–308.Google Scholar
Michiels M, Hendriks R, Heykants J. Radioimmunoassay of the new opiate analgesics alfentanil and sufentanil. Preliminary pharmacokinetic profile in man. J Pharm Pharmacol 1983; 35: 86–93.Google Scholar
Brignola C, Campieri M, Bazzocchi G, Farruggia P, Tragnone A, Lanfranchi GA. A laboratory index for predicting relapse in asymptomatic patients with Crohn's disease. Gastroenterology 1986; 91: 1490–1494.Google Scholar
Mazlam MZ, Hodgson HJ. Interaction between interleukin-6, interleukin-1 beta, plasma C-reactive protein values, and in vitro C-reactive protein generation in patients with inflammatory bowel disease. Gut 1994; 35: 77–83.Google Scholar
Oldenburg B, van Kats-Renaud H, Koningsberger JC, van Berge Henegouwen GP, van Asbeck BS. Chemiluminescence in inflammatory bowel disease: a parameter of inflammatory activity. Clin Chim Acta 2001; 310: 151–156.Google Scholar
Betrz RJ, Granneman GR. Use of in vitro and in vivo data to estimate the likelihood of metabolic pharmacokinetic interaction. Clin Pharmacokinet 1997; 32: 210–258.Google Scholar
Olstad OA, Skjelbred P. Comparison of the analgesic effect of a corticosteroid and paracetamol in patients with pain after oral surgery. Br J Clinic Pharmacol 1986; 22: 437–442.Google Scholar
Skjelbred P, Løkken P. Postoperative pain and inflammatory reaction reduced by injection of a corticosteroid. A controlled trial in bilateral oral surgery. Eur J Clin Pharmacol 1982; 21: 391–396.Google Scholar
Bueno L, Fioramonti J. Effects of inflammatory mediators on gut sensitivity. Can J Gastroenterol 1999; 13: 42A–46A.Google Scholar
Gebhart GF. Peripheral contributions to visceral hyperalgesia. Can J Gastroenterol 1999; 13: 37A–41A.Google Scholar
Gebhart GF. Visceral nociception: consequences, modulation and the future. Eur J Anaesthesiol 1995; 12: 24–27.Google Scholar
Giamberardino MA, Vecchiet L. Visceral pain, referred hyperalgesia and outcome: new concepts. Eur J Anaesthesiol 1995; 12: 61–66.Google Scholar
Verne GN, Robinson ME, Price DD. Hypersensitivity to visceral and cutaneous pain in the irritable bowel syndrome. Pain 2000; 93: 7–14.Google Scholar