Objective To systematically evaluate effectiveness, dosage and adverse reaction of sufentanil versus fentanyl for postoperative patient-controlled epidural analgesia (PCEA), so as to provide evidence for rational drug use in clinic. Methods Databases including The Cochrane Library, the special trials registered in the Cochrane anesthesia group, MEDLINE, EMbase, CBM, CNKI, VIP and WanFang Data were searched by the end of 2012, and the relevant periodicals were also manually searched to collect the randomized controlled trials (RCTs) on sufentanil versus fentanyl for postoperative patient-controlled epidural analgesia. According to the Cochrane Handbook 5.0, literature was screened, data were extracted, and quality of the included studies was critically assessed. Then meta-analysis was performed using RevMan 5.1 software. Results A total of 25 RCTs involving 1 944 patients were included. The results of meta-analyses showed that: a) as for visual analog scale (VAS), compared with the fentanyl group, the postoperative VAS at 2-hour, 4-hour, 8-hour, 12-hour, 24-hour and 48-hour was decreased in the sufentanil group; b) as for sedation scale, the fentanyl group, the postoperative sedation at 12-hour and 24-hour was lower in the sufentanil group when adopting 0 to 3 points scoring method, but there were no significant differences at other time points; c) as for drug dosage, compared with the fentanyl group, the postoperative drug consumption at 24-hour and 48-hour was less in the sufentanil group; d) as for adverse reaction, the incidence of postoperative nausea, vomiting, dizziness and somnolence in the sufentanil group was lower than those in the fentanyl group. But there was no significant difference in other adverse reactions such as skin itching, limbs numbness and motor disturbance between the two groups; and e) as for the demands of additional analgesic drugs, compared with the fentanyl group, the incidence of demanding additional analgesic drugs was lower in the sufentanil group. Conclusion Compared with fentanyl, sufentanil has better effects of analgesia and sedation for PCEA; Its dosage and incidence of adverse reactions are lower, so sufentanil is safer in clinic.
Pain is one of the main presenting symptoms in patients with acute pancreatitis (AP) and is also an important clinical factor affecting fluid resuscitation, enteral nutrition, early mobilization, organ support, and post-discharge recovery. The 2026 European interdisciplinary guidelines on pain management in AP were developed using a high-quality guideline development framework and generated 41 consensus-based recommendations across nine topics: general principles of acute pain management, pain pathophysiology, pain assessment, pharmacological treatment, epidural analgesia, complementary therapies, the impact of pain control on clinical outcomes, management of special populations, and discharge and follow-up. The key recommendations include that opioid use should not be delayed in patients with severe pain because of theoretical safety concerns; non-steroidal anti-inflammatory drugs generally do not increase adverse events or worsen AP severity; patient-controlled intravenous analgesia should not be used as a routine strategy; epidural analgesia may have potential benefits in severe AP; acupuncture and Chaiqin Chengqi decoction may be considered as limited adjunctive treatment options; and routine imaging follow-up is not supported for patients with pain after discharge, with selective investigations recommended based on clinical indications. This guideline interpretation discusses the key recommendations, evidence base, and implementation considerations in the context of clinical practice in China, aiming to provide a reference for standardizing AP pain management and optimizing patient outcomes.