Intranasal sufentanil is effective for postoperative analgesia in adults

Abstract

Purposes:The aim of this prospective, randomized, doubleblind 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. Objectif

Intranasal sufentanil/ketamine analgesia in children

“…Absorption parameters for nasal sufentanil were similar to those reported by others in adults where T max occurred at 10 min . Absorption of intranasal ketamine was more rapid than that reported by others where T max was 18–20 min , which is considerably longer than T max of 8.5 (CV 17.3%) min in the present study. This may be due to administration of ketamine as nasal drops in previous studies, while intranasal sufentanil/ketamine in the present study was administered as a nasal spray that distributes to a greater surface area of the nasal cavity.…”

“…In addition, combinations of sufentanil approximately 1 mcg·kg or ketamine 5 mg·kg with midazolam 0.3 mg·kg have been used for preinduction of anesthesia/postoperative analgesia . However, sufentanil nasal spray 0.5 mcg·kg −1 has been investigated for analgesia in adult patients, achieving pain relief after surgery or from limb extremity injuries .…”

“…This may be due to administration of ketamine as nasal drops in previous studies, while intranasal sufentanil/ketamine in the present study was administered as a nasal spray that distributes to a greater surface area of the nasal cavity. The time to intranasal sufentanil analgesia in adults was 10–20 min , and no data were available for intranasal ketamine analgesia in children. Time to sedation was approximately 10 min in pediatric studies investigating intranasal ketamine for preinduction .…”

Letter to the editor Intranasal sufentanil and its emerging clinical Applications: beyond its role in the emergency department

“…For instance, Mathieu et al in a recent study showed that efficacy was reached 20 minutes after internal administration of sufentanil. 3 They also reported that intranasal 0.050 g ϫ kg per puff of sufentanil resulted in a score less than 4 on a numeric rating scale (within 1 hour) in all patients who received the sufentanil.…”