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.
The study was supported by the foundation Apicil (MB) and the French Society of Emergency Medicine (MB). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
I have read the journal's policy and the authors of this manuscript have the following competing interests: MM has received grants and personal fees from MundiPharma and Purdue for speaking at conferences, and support from Roche Diagnostics for research unrelated to that presented here; GD has received personal fees from Zoll Medical for speaking at conferences; DV has received grants from Mundipharma for speaking at conferences, and grants from Astra Zeneca for research unrelated to that presented here. All other authors declare no competing interests.
Blancher M, Maignan M, Clapé C, Quesada J-L, Collomb-Muret R, Albasini F, et al. (2019) Intranasal sufentanil versus intravenous morphine for acute severe trauma pain: A double-blind randomized non-inferiority study. PLoS Med 16(7): e1002849. https:/
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Emergency Department and Mobile Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
HP2 Laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France
Clinical Pharmacology Unit, INSERM CIC1406, Grenoble Alpes University Hospital, Grenoble, France
Emergency Department and Mobile Intensive Care Unit, Saint-Jean-de-Maurienne Hospital, Saint-Jean-de-Maurienne France
Emergency Department, Centre Hospitalier Annecy Genevois, Annecy, France
Emergency Department and Mobile Intensive Care Unit, Metropole Savoie Hospital, Chambery, France
Emergency Department, Albertville-Moutiers Hospital, Moutiers, France
Emergency Trauma Unit, Department of Orthopedic Surgery and Sport Traumatology, Hôpital Sud, Grenoble Alpes University Hospital, Grenoble, France
Pharmacy Department, Grenoble Alpes University Hospital, Grenoble, France
Clinical and Innovation Research Department, Grenoble Alpes University Hospital, Grenoble, France
CNRS TIMCIMAG Laboratory, UMR 5525, University Grenoble Alpes, Grenoble, France
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