Sublingual sufentanil for dynamic and procedural pain in older patients with hip fracture

Introduction. Dynamic and procedural pain during mobilization, transfer and preoperative positioning in older patients with hip fracture is common and may remain undertreated. In this frail population, rapid onset analgesia with a strong safety profile is desirable and sublingual Sufentanil may represent a useful option in this time-sensitive perioperative scenario (1-3).Methods. We conducted an observational study including 67 older patients undergoing hip fracture surgery. Pain intensity was assessed before transfer to and on arrival in the operating theatre using the Numeric Rating Scale (NRS). Prespecified endpoints were analgesic response, overall clinical benefit for dynamic and procedural pain and any adverse effects after sublingual Sufentanil administration.Results. Sixty-seven patients were included in the study of which 83.6% were aged 70 and above. NRS reassessment in the operating theatre indicated clinically relevant analgesic benefit during mobilization, transfer, and perioperative preparation. A reduction of 1 or 2 points on the NRS scale was observed in 59.7% of cases and classified as responder. A reduction of 3 or more points on the NRS scale was observed in 85.1% of patients achieving overall clinical benefit. Tolerability was acceptable with 68.7% of patients displaying no adverse events. Mild transient drowsiness was the most frequently reported adverse event. No serious complications were recorded.Conclusions. From these preliminary data, sublingual Sufentanil appears to be safe in elderly patients undergoing hip fracture surgery. Its use appears to provide meaningful analgesia for dynamic and procedural pain with minimal undesirable effects in this patient population. Although further research is needed to better define the efficacy and safety of sublingual Sufentanil in elderly neck of femour fracture patients, these findings support its potential role within a structured perioperative analgesic pathway.