Analgesic effects of remifentanil combined with sufentanil in elderly patients during anesthesia

Objective To investigate the effects of remifentanil combined with sufentanil at different time points on stress and postoperative pain in elderly patients during anesthesia.Methods Eighty ASA Ⅰ or Ⅱ patients aged 61-72 years old, scheduled for elective abdominal surgery, were randomly divided into 2 groups.Group A: Anesthesia was induced with remifentanil (5 ng/ml) and maintained with remifentanil(4 ng/ml).The patients received PCIA at skin suture. Group B: The patients received remifentanil(2 ng/ml) and sufentanil in anesthesia induction and maintaining,then PCIA at skin suture. HR,MAP and SpO2were recorded before induction of anaesthesia(T1), during intubation (T2),at 1and 5 min after tracheal intubation(T3, T4), entering the abdominal cavity(T5), at 1 and 5 min after extubation(T6, T7). The plasma concentration of NE and E were tested at T1, T3, T6 and 6, 12, 24 hours after surgery(T8, T9,T10). The adverse cardiovascular events, eye-open time(the interval time between drugs withdrawal and opening eyes), extubation time (the interval time between drugs withdrawal and extubation), RS and OAA/S after extubation, VAS and amount of analgesic of 24 hours after surgery were also observed.Results Compared with T1, the MAP and HR were significantly decreased at T2(P0.01), HR at T3,T5-T7 in group A and T3,T6 in group B were increased and MAP at T3,T6, T7 in group A were higher(P0.05 or P0.01). Compared with T1, the NE and N of plasma at T3, T 6were significantly increased in each group (P0.01), and decreased at T9,T10 in each group(P0.05 or P0.01). The NE and N at T6,T8,T9in group A were significantly higher than in group B(P0.05). The incidence of adverse cardiovascular events was significantly higher in group A than in group B (P0.01). Restlessness and VAS scores at T8-T9 after extubation and amount of analgesic of 24 hours after surgery were higher in group A than in group B(P0.01).Conclusion Pre-injection of sufentanil can the postoperative acute pain caused by remifentanil and lower the perioperative stress response in elderly patients.