• Vincent Minville, Thomas Geeraerts, Olivier Fourcade, Damien Chaveron, Pascale Sanchez-Verlaan, Jean-Marie Conil, Agnès Sommet, and Michèle Génestal.
• Département d'Anesthésie et de Réanimation, CHU Toulouse, Université Toulouse III Paul Sabatier, Faculté de Médecine Toulouse-Rangueil, EA 4564-MATN, Institut Louis Bugnard, Toulouse, France. chaverondamien@yahoo.fr
• Eur J Anaesthesiol. 2012 Jun 1;29(6):280-5.

ContextPain and discomfort arising from the routine care of intubated patients in the ICU is managed by continuous infusion of narcotic and sedative drugs. There is benefit in keeping infusion rates low because lightening sedation improves clinical outcome, but this risks breakthrough pain. Management of this discomfort by bolus administration could permit lower background infusion rates, but the lowest effective bolus dose of sufentanil to achieve this is unknown.ObjectiveThe aim of this study was to determine the effective analgesic dose in 90% of intubated patients (ED90) in the ICU given bolus sufentanil. Pain was assessed using a Behavioural Pain Scale (BPS) requiring a score of 3-4 during moving to the lateral decubitus position.DesignProspective, dose response study.SettingA 16-bed multidisciplinary ICU in a French university hospital. Study period was from January to June 2010.PatientsIntubated and ventilated patients were eligible for the study once they had reached a BPS of 3 or 4 and Ramsay score of 3-5 within 48 h of admission to the ICU.InterventionThe analgesic efficacy of a sufentanil bolus was measured during successive lateral decubitus positioning over a 72-h study period, using the BPS scale. The dose was increased with each subsequent turn to lateral decubitus until a BPS score of 3-4 was obtained (dose escalation, starting at zero).Main Outcome MeasuresBPS, Ramsay score, heart rate and mean arterial pressure were collected before and during each procedure.ResultsA total of 25 patients were enrolled over 6 months. The ED90 bolus for sufentanil was 0.15 μg kg, but 40% of the patients subsequently demonstrated increased BPS with this dose.ConclusionThe effective dose in 90% was 0.15 μg kg during the first 5 days of sedation. There were no adverse effects. A pre-emptive sufentanil bolus can be used to treat anticipated pain in the ICU. Regular and frequent assessments of acute pain and sedation are essential for adjusting the dose, on a case-by-case basis. This strategy may help clinicians to keep background infusions of sedatives and narcotics as low as possible and may improve clinical outcome.Trial RegistrationClinicalTrials.gov NCT01356732.

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