Background: Sublingual sufentanil (SST) is used in the treatment of acute moderate to severe pain. Effects from its use for post operative ambulatory surgery has been shown, but those full benefits may not have been captured due to discharge. The aim of this study was to determine if its postoperative analgesic effects when given prior to emergence from anesthesia would show those benefits.

Methods: This was a prospective randomized controlled trial conducted at a single ambulatory surgery center. Patients aged 18-80 undergoing orthopedic surgery under general anesthesia were enrolled and randomized to receive either 30 mcg of SST or nothing 30 minutes prior to emergence. The primary outcome was the initial pain score, assessed via a standard 11-point numerical rating scale (NRS), on arrival to the post-anesthesia care unit (PACU).

Results: Fifty patients were included in the final analysis. The pain score on arrival to PACU was not significantly different between groups (SST: 4/10 [IQR 0,6]; control: 4/10 [IQR 3,5]; p = 0.378). However, patients in the sublingual sufentanil group used less opioid while in PACU, were more likely to be opioid free, and had improved overall benefit of analgesia scores (OBAS) compared to the control group.

Conclusion: While SST did not improve initial pain scores in PACU, its use may improve PACU opioid requirements and patient satisfaction with analgesia.