The effect of sublingual sufentanil on post-operative pain control in spine surgery.

INTRODUCTION: Patients undergoing spinal fusion surgery often experience moderate to severe pain during the first three post-operative days. Few data are currently available regarding the use of specific opioid analgesics for the spine surgery population, which routinely experiences significant acute pain. This study aims to examine the perioperative use of sublingual sufentanil tablet (SST) as part of the analgesic regimen for spine surgery. METHODS: This study was a prospective cohort (n = 30) with a two-arm (n = 80 each) historical control cohort. Both the prospective arm and the two retrospective control groups received a standard general anesthetic. The prospective arm received intraoperative sufentanil infusion and SST right after extubation and SST q1h in the post-anesthesia care unit (PACU) for Numerical Rating Scale (NRS) > 3, with intravenous hydromorphone used for breakthrough pain. The control groups received intraoperative sufentanil infusion alone or intraoperative remifentanil infusion alone, both with subsequent intravenous hydromorphone used for breakthrough pain (similar to the prospective SST arm). Multivariable linear regression models with inverse probability of treatment weighting were used to measure the effectiveness of SST in reducing the primary outcome of post-operative pain intensity scores in the PACU. RESULTS: A total of 190 patients were analyzed. The study group that received SST experienced lower average pain intensity scores in the PACU compared with the two historical control groups, with NRS scores of 3.22 in the SST group, 5.66 in the remifentanil group, and 5.05 in the sufentanil group. In the multivariable regression models, the SST group had an average PACU pain score that was 1.86 points lower (95 percent confidence interval [CI]: [-2.61, -1.10], p < 0.001) than the remifentanil group, and that was 1.10 points lower (95 percent CI: [-1.87, -0.34], p = 0.005) than the sufentanil group. CONCLUSION: SST appears to be a potentially beneficial adjunctive analgesic therapy in spine surgery patients who experience moderate to severe post-operative pain, resulting in improved pain intensity scores in the post-operative recovery period. Further analysis should examine the impact on longer-term post-operative opioid consumption and post-discharge pain-related outcomes.