A suzetrigine-based multimodal analgesic protocol in spine surgery: a single-center retrospective cohort study of opioid consumption, pain, and length of stay.

Background: Suzetrigine is an oral selective NaV1.8 inhibitor approved for moderate-to-severe acute pain. We evaluated the addition of this to multimodal analgesia after spine surgery. Methods: This single-center retrospective prepost cohort included 100 adults undergoing spine surgery (50 suzetrigine, 50 controls). The primary endpoint was cumulative morphine milligram equivalents (MME) within 48 hours. Secondary outcomes included MME at postoperative day (POD) 0 and at discharge, pain scores, length of stay (LOS), bowel function, falls, and 30-day readmission. Multivariable models adjusted for age, BMI, baseline pain, chronic opioid use, instrumentation, and race. Results: Race/ethnicity differed between cohorts (p = .032); most other measured baseline characteristics were similar. In the direct 48-hour analysis (44 vs. 43 patients), MME was lower with suzetrigine (median 20.0 vs. 34.0; p = .032; d = -0.45). An all-patient sensitivity analysis using total inpatient MME through discharge for patients discharged before 48 hours was also significant (20.0 vs. 31.8; p = .021). POD0 MME (5.0 vs. 10.0; p = .010) and discharge MME (5.0 vs. 15.0; p = .014) were lower with suzetrigine. LOS did not differ (p = .171). After adjustment, the suzetrigine coefficient for 48-hour MME did not reach significance (β = -9.45; p = .065), and there was no adjusted LOS association (β = -0.43; p = .171). Conclusions: Suzetrigine was associated with lower unadjusted 48-hour, POD0, and discharge opioid consumption, although the adjusted 48-hour association did not reach statistical significance. No LOS difference was observed. Prospective validation is warranted.