Sufentanil sublingual may lower opioid use after THA, TKA
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Use of sufentanil sublingual in a multimodal analgesic regimen may lower opioid utilization, lead to more rapid discharge and reduce admissions to skilled nursing facilities in patients undergoing total hip or knee arthroplasty.
Lawrence Wiesner, DO, and colleagues compared the outcomes of 53 patients undergoing THA or TKA who received a 30-mcg tablet of Dsuvia (sufentanil sublingual, AcelRx Pharmaceuticals) in the post-anesthesia care room following either spinal or general anesthesia with 57 matched historical controls who received standard IV opioids. Outcomes assessed included overall number of opioids administered throughout the hospital stay, patient length of stay and patient disposition at discharge. Researchers reported all patients received NSAIDs and acetaminophen, with peripheral anesthesia blocks for knee arthroplasty, and IV and oral opioids were used as rescue analgesics.
Researchers found similar patient demographics, anesthesia techniques and type of surgery between the two groups. Results showed patients who received the sufentanil sublingual tablet utilized approximately 30% less morphine milligram equivalents throughout their hospital stay. Patients who received a sufentanil sublingual tablet also experienced a shorter length of hospital stay, with 7.5% of patients in the sufentanil sublingual tablet group staying 2 or more nights vs. 17.5% of patients in the control group, according to results. Researchers noted 15.8% of patients in the control group were discharged to a skilled nursing facility vs. none in the sufentanil sublingual tablet group.
“The results from this study showing less overall opioid utilization and more rapid discharge following joint replacement are impressive, especially given the fact that only a single dose of Dsuvia was administered. We used to routinely get calls from the floor nurses the day of surgery when the spinal anesthetic had worn off with patients having rebound pain, but those calls immediately diminished following the adoption of Dsuvia into our current practice,” Wiesner, lead author of the study, said in a press release from AcelRx Pharmaceuticals. “The joint replacement patients are older and have many comorbidities, therefore it is advantageous to utilize an opioid that not only provides rapid analgesia with initial dosing, but also has a low peak plasma concentration, a high therapeutic index and a 13-hour terminal half-life allowing lower postoperative opioid requirements and a faster discharge.”
Reference:
AcelRx Pharmaceuticals announces publication of clinical data showing reduced hospital length of stay and reduced opioid utilization with use of sublingual sufentanil in total joint replacement surgery. https://www.acelrx.com/news-releases/news-release-details/acelrx-pharmaceuticals-announces-publication-clinical-data-1. Published Dec. 15, 2021. Accessed Dec. 20, 2021.
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Opioid reduction in the orthopedic perioperative setting has been advanced utilizing enhanced recovery after surgery protocols with a focus on utilizing a multimodal approach to inhibiting pain pathways. Yet, despite advances in regional anesthetic blocks, long-acting local anesthetics and non-opioid analgesics, the administration of opioids during anesthesia and in the immediate postoperative period is still common as shown by the current study.
The question becomes, “Is there an opportunity within our current enhanced recovery after surgery approach to further reduce perioperative opioid exposure by our selection of the opioid analgesic that we utilize?”
Opioid stewardship requires a team approach. Surgeons and anesthesiologists need to discuss and develop perioperative strategies to focus on the entirety of the patient’s opioid exposure, including intraoperatively, postoperatively and at discharge. The findings of this study identify sufentanil sublingual tablet as a viable option for the advancement of the ideals of opioid stewardship with the potential to reduce perioperative opioid usage and, in turn, potentially decrease opioid-related adverse drug events, length of stay and, hopefully, overall postoperative opioid exposure, such that the risk of physical dependence and addiction may also be reduced.
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