Sufentanil Superior to Remifentanil for Liver Cancer Surgery in Elderly

The use sufentanil vs remifentanil anesthesia in curative resection for hepatocellular carcinoma (HCC) was associated with better outcomes in patients aged 65 and older, according to study findings published in Pain Therapy.

Liver cancer incidence is particularly high in China, which has half of all HCC cases seen worldwide, the study authors noted. Chinese investigators therefore sought to compare outcomes associated with the use of sufentanil and remifentanil anesthesia in patients aged 65 and older undergoing curative resection for HCC.

Investigators retrospectively evaluated medical records of 460 patients at least 65 years of age undergoing curative resection for HCC at a hospital in Wuhan, China, between 2017 and 2020. The patients were divided into a sufentanil group (n=332) and a remifentanil group (n=138). Baseline patient characteristics did not differ significantly between groups.

The researchers analyzed data on vital signs for 5 time points: before and after anesthesia was induced, at the end of surgery, and 24 hours and 72 hours after surgery. Vital signs included mean arterial pressure (MAP); heart rate (HR); arterial oxygen saturation (SpO₂); the distribution of T-cell subsets among CD3, CD4, and CD8 cluster groups; and the distribution of the stress response index. The latter comprised measurements of cortisol, interleukin-6, C-reactive protein, and glucose levels. The researchers also analyzed data on postoperative adverse events.

In repeated-measure analysis of variance, the researchers found that sufentanil outperformed remifentanil. Significant differences were seen in MAP, HR, and SpO₂ outcomes (all P <.01). Further analysis found these differences were significant after induction of anesthesia and at the end of surgery, but not at the other time points. The researchers also noted differences in the distributions of T-cell subsets and the stress response index between treatment groups (P <.01) after controlling for baseline patient demographic and treatment characteristics.

According to the researchers, these findings indicated that the sufentanil group had more stable hemodynamic and respiratory function, less reduction in T- lymphocyte subsets, and a more stable stress response index than the remifentanil group. No significant between-group differences were seen in adverse reactions (P =.72).

Study limitations include the retrospective design; the relatively small group of patients receiving remifentanil anesthesia; and the fact that study participants came from a single center. These limitations limit the generalizability of study results, the researchers noted.

“[S]ufentanil was associated with improved hemodynamic and respiratory function, less stress response, less inhibition of cellular immunity, and similar adverse reactions compared with remifentanil,” the study authors concluded.