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Opioid Analgesic (Ultra-Potent) Pregnancy: Used for labour analgesia (intrathecal) — established safety record

Sufentanil

Brand names: Sufenta, Dsuvia (sublingual)

Adult dose

Dose: Intrathecal: 2.5–10 mcg added to spinal; Epidural: 10–50 mcg bolus; IV supplement: 0.1–0.4 mcg/kg
Route: Intrathecal / Epidural / IV
Frequency: Single dose or infusion
Max: Titrated to clinical response
5–10× more potent than fentanyl. Used intrathecally for post-operative and labour analgesia. Highly lipophilic — rapid onset in neuraxial use. Also available as sublingual tablet (Dsuvia/Zalviso) for acute pain management.

Paediatric dose

Dose: 0.1–0.4 mcg/kg
Route: IV
Frequency: Bolus or infusion
Max: Titrated to effect
Paediatric cardiac surgery: 5–20 mcg/kg IV under specialist guidance. Seek specialist opinion for other paediatric indications.

Dose adjustments

Renal

No significant dose adjustment — hepatically metabolised.

Hepatic

Caution in severe hepatic impairment — reduced clearance.

Paediatric weight-based calculator

Paediatric cardiac surgery: 5–20 mcg/kg IV under specialist guidance. Seek specialist opinion for other paediatric indications.

Clinical pearls

  • Antidote: naloxone 0.4–2 mg IV (titrate carefully)
  • Intrathecal sufentanil provides superior analgesia with less motor block than bupivacaine alone in labour — widely used in combined spinal-epidural (CSE) technique
  • Neuraxial pruritus — unique opioid side effect mediated by spinal opioid receptors; not an allergic reaction; treat with low-dose naloxone or ondansetron

Contraindications

  • Respiratory depression without ventilatory support
  • MAOIs within 14 days

Side effects

  • Respiratory depression
  • Pruritus (neuraxial — opioid receptor mediated; treat with naloxone 40 mcg IV or ondansetron)
  • Nausea/vomiting
  • Urinary retention (neuraxial)
  • Chest wall rigidity (high-dose IV bolus)

Interactions

  • MAOIs (contraindicated within 14 days)
  • CNS depressants (additive)
  • CYP3A4 inhibitors (increase levels)

Monitoring

  • Respiratory rate and depth
  • SpO2
  • Sedation score
  • Level of sensory block (neuraxial)

Reference: BNFc; BNF 90; OAA Guidelines on Labour Analgesia; Miller's Anaesthesia 9th Ed. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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