Comparison of efficacy and safety profiles of perioperative sufentanil and remifentanil: a systematic review and meta-analysis with trial sequential analysis.

Background: Sufentanil and remifentanil are commonly used during general anesthesia. This systematic review and meta-analysis with trial sequential analysis of randomized controlled trials (RCTs) aims to comprehensively evaluate and compare the efficacy and safety profiles of perioperative sufentanil and remifentanil administration in patients undergoing surgery under general anesthesia.

Methods: This study was registered in INPLASY (INPLASY202270070). A comprehensive search was performed using MEDLINE, EMBASE, CENTRAL, Web of Science, and Google Scholar to identify all RCTs comparing the efficacy of the intraoperative use of sufentanil to that of remifentanil. The primary outcome were the postoperative pain scores measured using visual analogue scale (VAS) or numerical rating scales (NRS). The secondary outcomes were the postoperative analgesic use, time to first analgesic need, intraoperative hemodynamic profiles, postoperative nausea and vomiting (PONV), incidence of respiratory depression, and recovery characteristics.

Results: A total of 31 studies were included in the final analysis. Postoperative pain score was significantly higher in remifentanil group than that in sufentanil group, with a small effect size (standardized mean difference [SMD] =  - 0.47; 95% confidence interval [CI] = 0.24 to 0.70). Postoperative analgesic amount used was lower in sufentanil group than that in remifentanil group, with a medium effect size (SMD = 0.55; 95% CI = 0.12 to 0.99). In terms of hemodynamic profiles, intraoperative systolic blood pressure (mean difference [MD] =  - 6.30; 95% CI =  - 10.76 to - 1.85), mean arterial pressure (MD =  - 6.38; 95% CI =  - 10.25 to - 2.51), and heart rate (MD =  - 4.16; 95% CI =  - 6.65 to - 1.68) were lower in remifentanil group than in sufentanil group. Incidence of postoperative nausea (relative risk = 1.39; 95% CI = 1.13 to 1.71) was higher in remifentanil group than in sufentanil group. The remifentanil group showed a faster recovery profile than the sufentanil group.

Conclusions: Compared with remifentanil, sufentanil demonstrated superior efficacy in postoperative pain management and superior safety profiles with respect to postoperative nausea and hemodynamic stability; however, remifentanil showed a faster recovery profile.

Systematic review registration: International Prospective Register of Systematic Reviews (INPLASY), NPLASY202270070.