Target-Controlled Infusion with PSI- and ANI-Guided Sufentanil Versus Remifentanil in Remimazolam-Based Total Intravenous Anesthesia for Postoperative Analgesia and Recovery After Laparoscopic Subtotal Gastrectomy: A Randomized Controlled Study

<b>Background/Objectives:</b> Target-controlled infusion (TCI) with remifentanil or sufentanil provides stable and effective anesthesia. This randomized prospective trial investigated the comparative efficacy of TCI using sufentanil versus remifentanil on postoperative analgesia and recovery profiles in patients after laparoscopic subtotal gastrectomy under remimazolam-based total intravenous anesthesia (TIVA). <b>Methods:</b> Sixty-six patients who underwent laparoscopic subtotal gastrectomy were randomly allocated to receive either TCI-based sufentanil or remifentanil in TIVA with remimazolam. The primary endpoint was the cumulative fentanyl consumption within 24 h after surgery. The secondary outcomes were pain intensity at rest and during activity, and recovery parameters including time to extubation, length of post-anesthesia care unit (PACU) stay, and quality of recovery (QoR-40) on postoperative day 1 (POD1). <b>Results:</b> The cumulative fentanyl consumption over the 24 h postoperative period was similar between the two groups. However, compared with the remifentanil group, the sufentanil group required significantly less fentanyl during the immediate postoperative period (0-0.5 h) (<i>p</i> < 0.001) and exhibited lower pain scores both at rest and during activity during the first postoperative hour (<i>p</i> < 0.001). Although the Sedation-Agitation Scale score at PACU admission was significantly lower in the sufentanil group (<i>p</i> < 0.001), the overall recovery profiles, including time to extubation, PACU stay, and QoR-40 scores on POD 1, were comparable between the groups. <b>Conclusions:</b> TCI-based sufentanil and remifentanil in TIVA with remimazolam showed similar overall analgesic efficacies and recovery outcomes after laparoscopic subtotal gastrectomy. Both opioid strategies are effective for postoperative pain management, with a slight advantage in immediate postoperative pain control for sufentanil.