Sublingual Sufentanil Tablet Linked to Reduction in Opioid Requirement Rates

Justin A. Mottaghi, MD

The recent introduction of the sublingual sufentanil tablet (SST) may have advantages in rapid onset for post-operative pain after ambulatory surgery, compared to intravenous opioids.

Previous studies have not determined if preemptive intraoperative dosing of SST could aid in post-operative pain management.

Investigators, led by Justin A. Mottaghi, MD of the University of Minnesota, found that SST (DSUVIA) administered intraoperatively did not affect patient pain scores on posit anesthesia care unit (PACU) arrival, but it did show improvements in opioid requirement rates.

The study was presented at the ASRA 46th Annual Regional Anesthesiology and Acute Pain Medicine Meeting.

Study

The investigator’s primary objective determined if 30 mg SST administered prior to emergence from anesthesia was effective in reducing initial PACU pain scores, in comparison to no intervention.

Further secondary outcomes included opioid use, percentage of patients opioid free in PACU, and measures of discharge time.

Mottaghi and team designed a prospective randomized controlled trial (RCT) conducted at an ambulatory surgery center.

An outline of the trial included patients aged 18–30 years, undergoing orthopedic surgery under generalized.

Patients were enrolled and randomized to receive either 30 mg SST or no intervention 30 minutes prior to emergence.

The study’s power analysis was based on a recent RCT, with average initial pain scores of 6.63 (SD, 2.13) for patients undergoing orthopedic surgery.

Results

A total of 50 patients were included in the final analysis. There was no significant different in baseline characteristics or duration of surgery between the 2 groups.

Investigators found that the pain score on arrival to PACU did not have a significant difference between either group. The SST group had a score of 4.0 (IQR 0,6) and the control group had a score of 4.0 (IQR 3,5), all P = .378.

However, the SST group required 50% less opioids in the PACU (P = .018), with a significant higher number of patient’s opioid free (36%) compared to the control group (8%), P = .037.

Investigators also found SST patients had improved overall benefit of analgesia scores (OBAS), when compared to the control group (P = .006). The OBAS included assessments of pain intensity, adverse effects, and patient satisfaction with analgesia.

Conclusion

Investigators concluded that the sublingual sufentanil administered intraoperative did not affect patient pain scores in PACU arrival, but patients showed improvement in PACU opioid requirements and OBAS scores.

Data show more patients were opioid-free in PACU.

“Perhaps the most compelling result of this study was the significant difference in OBAS and opioid-free patients, reflecting greater patient satisfaction in the SST group,” investigators wrote.

The team noted limitations of the study included a lack of active comparator for the SST, so there was no preemptive opioid analgesia in the control group, as well as a lack of data on additional analgesic benefit of SST beyond the discharge postoperative period.

The study, “Intraoperative Sublingual Sufentanil For Acute Pain in the Ambulatory Surgery Center,” was presented online by the ASRA.