Intranasal sufentanil as good as IV morphine for emergency pain relief, study finds

In patients presenting to an emergency department with severe traumatic pain, intranasal sufentanil was as good as standard-of-care intravenous morphine for pain relief, according to a new study published this week in PLOS Medicine by Marc Blancher of Grenoble Alpes University Hospital, France, and colleagues.

Intravenous morphine is the most commonly used strong analgesic for relieving acute pain in the emergency room, but the need to get an IV line started before administration limits its rapid use. In the new study, researchers randomized 136 patients who presented to the emergency departments of six hospitals across France. Patients ranged in age from 18 to 75 years old and had traumatic pain self-evaluated as at least a six out of ten on a rating scale. 69 patients received intranasal sufentanil plus an intravenous placebo and 67 patients received intravenous morphine plus an intranasal placebo.

Patients' pain rating dropped by 4.1 points (97.5% CI -4.6 to -3.6) in the 30 minutes after analgesic administration in the group receiving intravenous morphine, and by 5.2 points (-5.7 to -4.6) with intranasal sufentanil. Intranasal sufentanil was shown to be non-inferior to intravenous morphine in terms of pain control at 30 minutes (p<0.001), as well as superior to morphine (p=0.034). 6 severe adverse events were observed in the intranasal sufentanil group and 2 in the intravenous morphine group, indicating that further research will be needed on the safety of intranasal sufentanil. Co-analgesics were used more often in the intranasal sufentanil group.

"The use of intranasal sufentanil might provide an easy and time saving solution in the management of acute pain," the authors say.