43 - Epidural sufentanil  pp. 191-193

Epidural sufentanil

By Jill Zafar, Anthony T. Yarussi and Laura Mechtler

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Generic Name: sufentanil

Trade Name: Sufenta

Chemical Name:N-{4-(methoxymethyl)-1-(2-thiophen-2-ylethyl)piperidin-4-yl}-N-phenylpropanamide

Manufacturer: Claris Lifesciences Inc., 542 Industrial Way West, Eastontown, NJ 07724

Class: opioid analgesic

Chemical Structure: see Figure 43.1

Description

Sufentanil is a potent opioid analgesic that is primarily administered intravenously as an adjunct in anesthesia during surgery or as an epidural analgesic during labor and vaginal delivery. Sufentanil is a synthetic anilinopiperidine that binds to and activates the mu opioid receptors on neuronal cell membranes which are present in large quantities in the periaqueductal gray matter (human brain) and the substantia gelatinosa (spinal cord). Activation of mu receptors predominantly causes analgesia and sedation along with other side effects. Sufentanil is the thienyl analog of fentanyl and is approximately 5–10 times more potent than fentanyl.

Mode of activity

Sufentanil (as other opioids) given epidurally can produce analgesia one of three ways. It can spread cephalad in the CSF to supraspinal centers, be absorbed systemically and transfer to supraspinal centers, or act directly in the dorsal horn of the spinal cord on the spinal opioid receptors. It is felt that the main site of action of epidural sufentanil is presynaptic modulation of the nociceptive signal in the lamina of Rexed in the spinal cord. Sufentanil has a fast onset of action when it selectively binds to the spinal mu receptors.

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