Intranasal Sufentanil May Be an Option for Managing Severe Orthopaedic Trauma Pain

In the emergency department, trauma patients – including patients with traumatic orthopaedic injuries of the shoulder, elbow, wrist, hip, knee, and ankle – who receive intranasal sufentanil experience pain relief equal to that of intravenous (IV) morphine, according to a multicenter study published in PLOS Medicine.

The prospective, randomized, non-inferiority trial included 136 patients who presented at the emergency department of 6 hospitals across France between November 4, 2013, and April 10, 2016. These patients were randomized into 2 groups:

  • Intranasal sufentanil plus IV placebo (n=69); 0.3 μg/kg for the initial dose of sufentanil plus additional doses of 0.15 μg/kg at 10 and 20 minutes for patients with a pain rating above 3
  • IV morphine plus intranasal placebo (n=67); 0.1 mg/kg for the intial dose of morphine and additional doses of 0.05 mg/kg at 10 and 20 minutes for patients with a pain rating above 3

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Patients ranged in age from 18 to 75 years old and had traumatic pain self-evaluated as at least a 6 out of 10 on a 10-point numeric pain rating scale.

Patients’ pain ratings dropped by 4.1 points in the 30 minutes after analgesic administration in the group receiving IV morphine and by 5.2 points in the group receiving intranasal sufentanil. Intranasal sufentanil was shown to be non-inferior to IV morphine for managing trauma-related pain at 30 minutes (P<0.001) and at the dosage studied, may be superior to morphine in that time period (P=0.034).

Six severe adverse events were observed in the intranasal sufentanil group and 2 were observed in the IV morphine group, indicating that further research will be needed on the safety of intranasal sufentanil.

The authors conclude that, “[t]he use of intranasal sufentanil might provide an easy and time saving solution in the management of acute pain.”


Blancher M, Maignan M, Clapé C, et al. Intranasal sufentanil versus intravenous morphine for acute severe trauma pain: a double-blind randomized non-inferiority study. 2019. PLoS Med 16(7): e1002849.

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