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Intranasal sufentanil is effective for postoperative analgesia in adults

[L’administration intranasale de sufentanil est efficace pour l’analgésie postopératoire chez les adultes]

From the Department of Anesthesiology, Erasme University Hospital, Free University of Brussels, Brussels, Belgium.

Address correspondence to: Dr. Nathalie Mathieu, Department of Anesthesiology, Erasme University Hospital, Route de Lennik 808, B-1070 Brussels, Belgium. Phone: +32 2 555 3919; Fax: +32 2 5554363; E-mail: nmathieu{at}ulb.ac.be

Purposes: The aim of this prospective, randomized, double-blind study was to compare two doses of intranasal sufentanil for postoperative analgesia, titrated according to individual requirements based upon a numeric rating scale (NRS) from 0 to 10 for pain.

Methods: Forty patients, American Society of Anesthesiologists physical status I–II, scheduled for herniorrhaphy or hemorrhoidectomy under general anesthesia, were included when postoperative NRS was > 3. Nurses used a nasal puff device delivering a constant volume. Patients were randomized into two groups: Group A patients received a dose of 0.025 µg·kg^–1 /puff, Group B patients a dose of 0.05 µg·kg^–1 /puff. Puffs were administered as often as needed to obtain NRS 3, with an interval time of five minutes. Hemodynamic, respiratory measures and sedation were recorded every five minutes.

Results: The probability of persistence of pain in Group B was consistently lower than in Group A. After 20 min, 20% of the patients had a NRS score > 3 in Group B, as opposed to 60% in Group A. At 60 min, no patient had a NRS > 3 in Group B, whereas there was a probability of 20% to record a NRS > 3 for Group A. Hemodynamic, respiratory parameters and sedation remained stable with no intergroup differences.

Conclusions: Nasal administration of 0.050 µg·kg^–1 /puff sufentanil allowed a NRS < 4 to be attained within one hour in all patients, with efficacy achieved after 20 min. These findings suggest that the intranasal route is an effective mode of sufentanil administration for immediate postoperative analgesia in adult patients.