Intranasal Sufentanil Effective for Acute Severe Trauma Pain

By Will Boggs MD

July 17, 2019

NEW YORK (Reuters Health) - Intranasal sufentanil is as effective as intravenous morphine for treating acute severe trauma pain, according to results from a noninferiority study.

The optimal emergency treatment for acute pain would allow quick administration, provide rapid onset of action, and be powerful enough to achieve a level of pain as low as possible. Intranasal sufentanil appears to satisfy these criteria, but there are few studies of its effect on acute severe pain.

Dr. Marc Blancher from Grenoble Alpes University Hospital in France and colleagues from six French hospital emergency departments (EDs) assessed the noninferiority of the analgesic effect and safety of titrated intranasal sufentanil (INS) versus intravenous morphine (IVM) in the ALGOFINE trial of 136 patients with acute traumatic pain.

The mean pain scores at baseline were 7.6/10 in the IVM group and 7.9/10 in the INS group.

In the per protocol analysis, these scores improved by a mean 4.1/10 in the IVM group and 5.2/10 in the INS group at 30 minutes (the primary endpoint), which satisfied the noninferiority criterion.

Results were similar in the intention to treat analysis (mean improvements, 4.4/10 in the IVM group and 5.1/10 in the INS group), according to the July 16th PLoS Medicine online report.

In secondary analyses, INS was superior to IVM for pain reduction at 30 minutes in the intention to treat population, but the difference between the groups was clinically nonsignificant (0.7/10).

Adverse event rates did not differ significantly between the groups, and median patient satisfaction scores at the end of the procedure were 80/100 in both groups.

"The intranasal route, with no need to obtain a venous route, may allow early and effective analgesia in emergency settings and in difficult situations," the authors conclude. "Confirmation of the safety profile of INS will require further large studies."

Dr. Fabien Lemoel from Hopital Pasteur, Nice, France recently reported the effectiveness of intranasal sufentanil in the emergency department triage zone for severe acute traumatic pain. He told Reuters Health by email, "I totally share the authors' opinion that INS would be helpful in pre-hospital settings where IV access may be impossible or very difficult, so IVM would lead to delayed time-to-analgesia."

"I would add the interesting possibility of starting opioid analgesia for severe pain as soon as possible in the emergency department, i.e., in the triage zone," he said. "Indeed, busy EDs have big difficulties in maintaining appropriate pain management, especially in overcrowded conditions, because of delays in treatment initiation, as nurses can be occupied elsewhere."

"Titrated INS is feasible, at least as effective as IVM, and much easier/faster to deliver," Dr. Lemoel concluded. "Thus, INS has to be considered as a very appropriate way of analgesia in ED settings, where time is gold, and guidelines should take this into account."

Dr. Blancher did not respond to a request for comments.


PLoS Med 2019.


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