Analgesic effect of intraoperative sufentanil on postoperative pain in patients undergoing robot-assisted urologic surgery: a retrospective propensity score-matched analysis.

BACKGROUND: Robot-assisted urologic surgery is associated with reduced intraoperative bleeding and shortened hospital stays; however, postoperative pain remains concerning. Thus, the authors investigated whether intraoperative sufentanil is more effective than remifentanil in reducing postoperative pain and analgesic consumption. METHODS: Patients undergoing robot-assisted urologic surgery (March 2023 to March 2024) were divided into the sufentanil or remifentanil groups and matched by propensity score. The primary outcome was the distribution of pain severity after surgery. Secondary outcomes included pain scores and rescue analgesic consumption. RESULTS: Among 832 eligible patients, 194 were matched from each group. The distribution of pain severity after surgery was significantly different between groups (rank-biserial correlation -0.34, 95% confidence interval [CI] -0.43 to -0.24; P < 0.001). The sufentanil group had more patients with no/mild pain (27.8% vs. 4.6%, risk difference [RD] 23.2%, 95% CI 16.2% to 30.2%; P < 0.001) and fewer patients with severe pain (32.5% vs. 57.2%, RD -24.7%, 95% CI -34.3% to -15.2%; P < 0.001). Immediate postoperative pain score was lower with sufentanil (6 [3, 7] vs. 7 [6, 8], Hodges-Lehmann estimator [HL estimator] -1, 95% CI -2 to -1; P < 0.001). During the 48-hour postoperative period, the sufentanil group required significantly lower opioid rescue analgesic consumption (13.3 [5, 22.5] vs. 20 [10, 29.6] mg of morphine-equivalent dose, HL estimator -5 mg, 95% CI -6.7 to -2.5 mg; P < 0.001). CONCLUSIONS: Intraoperative sufentanil was associated with lower postoperative pain and analgesic consumption than was remifentanil in patients undergoing robot-assisted urologic surgery.