Intranasal Sufentanil for Postoperative Pain Control in Lower Abdominal Pediatric Surgery

The most important role in postoperative pain management is still played by opioid administration through various modes. For the last few years, there has been an intensive search for alternative mode of opioid administration in pain management. The intranasal modes of opioid administration seems to be an attractive alternative. Sixty boys (aged 0.5-6 yr); ASA (American Society of Anesthesiologists) physical status I, who were candidates for lower abdominal surgery, were included in this prospective randomized, controlled study. Five minutes before extubation, patients were randomized to two groups and allocated to receive intranasal sufentanil (0.7 μg/kg) or normal saline, using a double-blinded study design. Satisfactory analgesia was achieved with intranasal sufentanil. It was effective after 10 minutes with the least pain scores (pain score 2.3±0.4 vs. 4.1±0.5) (p = 0.001). Pain scores in 15, 20 and 25 minutes were similar in sufentanil group. None of patients had bradycardia, hypotension or SpO2 (arterial O2 saturation) <95%. High bioavailability of sufentanil after intranasal administration due to direct entrance of the drug into the systemic circulation and avoidance of the hepatic first- pass effect makes sufentanil an opioid with rapid onset and limited duration. As it has minimal side effects, sufentanil is one of the best choices for postoperative pain control in children. We used 0.7 μg/kg of intranasal sufentanil and found satisfactory analgesia accompanied with least side effects.