The following is a summary of “A systematic review of sufentanil for the management of adults with acute pain in the emergency department and pre-hospital setting,” published in the August 2023 issue of Emergency Medicine by Hutchings et al.

Pain is frequently encountered in the Emergency Department (ED) and pre-hospital setting and often necessitates the administration of opioid analgesics. The objective was to compile the existing evidence regarding the efficacy of sufentanil in providing acute pain relief for adult patients in the pre-hospital or emergency department (ED) environment. This systematic review followed the guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Medline, Embase, Cochrane CENTRAL, and CINAHL databases were systematically queried from their inception until February 1, 2022. 

The medical literature was also searched, where researchers incorporated randomized controlled trials involving adult patients experiencing acute pain who received sufentanil treatment. Two medical reviewers independently conducted screening, full-text review, and data extraction. The primary outcome observed was a decrease in pain. Secondary outcomes encompassed adverse events, rescue analgesia requirements, and patient and provider satisfaction.

The bias assessment was conducted utilizing the Cochrane Risk of Bias 2 tool. A meta-analysis was not performed due to the presence of heterogeneity. Out of 1120 distinct citations, four research papers (three focusing on emergency department settings and one on pre-hospital care) fully met the inclusion criteria, with a combined sample size of 467 participants. The overall quality of the included studies was deemed to be of a high standard. Intranasal (IN) sufentanil demonstrated superiority over placebo in pain relief at the 30-minute mark (with a difference of 20.8%, 95% CI 4.0–36.2%, P = 0.01). Both intranasal (IN) administration, as demonstrated in two studies, and intravenous (IV) sufentanil, as shown in one study, exhibited comparability to intravenous (IV) morphine. 

Mild adverse events were frequently observed, with a greater likelihood of minor sedation in patients who received sufentanil. There were no significant adverse events necessitating advanced medical interventions. Sufentanil demonstrated comparable efficacy to intravenous morphine and exhibited superiority over placebo in alleviating acute pain in the emergency department (ED) environment. The safety profile of sufentanil is similar to intravenous morphine in this context, with minimal apprehension for significant adverse events. The intranasal formulation may offer an alternative, expedited, non-parenteral pathway that could benefit distinct emergency departments and pre-hospital patient populations. Given the limited sample size of this review, it is necessary to conduct more extensive studies to validate the safety.

Source: sciencedirect.com/science/article/abs/pii/S0735675723002085