Suzetrigine As A Novel Non-opioid Analgesic: Reducing Postoperative Opioid Consumption In Autologous Breast Reconstruction

PURPOSE: Postoperative opioid use remains high across surgical populations and contributes significantly to dependence, particularly among opioid-nave patients. Autologous breast reconstruction is associated with substantial postoperative pain, with 6-10% of patients developing opioid dependence following surgery. This highlights the need for effective non-opioid analgesics within multimodal pain regimens. Suzetrigine, a novel peripherally selective sodium channel blocker recently approved by the FDA for acute pain, acts by inhibiting voltage-gated sodium channels in peripheral sensory neurons, reducing pain signaling with minimal side effects that are common with opioid pain medications. The role of suzetrigine in autologous breast reconstruction has not been studied. Given the high pain burden in this population, this study aims to compare postoperative opioid requirements in patients receiving perioperative suzetrigine versus controls undergoing DIEP flap breast reconstruction. METHODS: Patients who underwent DIEP flap reconstruction were reviewed to identify two consecutive cohorts of 10 patients each: a control group without suzetrigine exposure (November-December 2023) and a study group with perioperative suzetrigine administration (July-October 2025). Patients treated in the intervening period were excluded due to intraoperative methadone use, which could confound postoperative opioid consumption. Data collected included patient demographics, operative details, hospital length of stay (LOS), postoperative complications, and postoperative opioid use per patient. The primary outcome was daily and total postoperative opioid requirements, recorded in oral morphine milligram equivalents (MME). RESULTS: Postoperative opioid consumption, expressed as total MME per patient, was significantly reduced in the suzetrigine group across the postoperative period. On postoperative day (POD) 0, mean opioid consumption was similar between groups (32.0 20.5 MME vs. 26.1 18.0 MME; p = 0.50). By POD 1, patients receiving suzetrigine required markedly fewer opioids compared to controls (22.2 25.7 MME vs. 65.6 38.2 MME; p = 0.008), representing a greater than 65% reduction in postoperative opioid use. This significant difference persisted through POD 2 (17.7 16.4 MME vs. 49.3 34.6 MME; p = 0.021), reflecting a greater than 60% reduction. Cumulatively, total opioid consumption across the entire inpatient stay was more than 50% lower among suzetrigine recipients (69.1 53.0 MME) compared to controls (169.3 101.7 MME; p = 0.015). No major complications were observed in the suzetrigine group. CONCLUSIONS: In this early clinical experience, perioperative administration of suzetrigine, a novel non-opioid sodium channel blocker, in patients undergoing DIEP flap reconstruction was associated with a greater than 50% reduction in postoperative opioid consumption without compromising pain control or safety. These findings underscore suzetrigines potential as an effective adjunct within multimodal analgesia regimens. Given the ongoing opioid epidemic, this marked reduction in opioid requirements represents a meaningful step toward reducing postoperative opioid use. While limited by small sample size and retrospective design, our study provides compelling preliminary evidence supporting suzetrigines clinical utility. Larger, prospective trials are warranted to validate these results and further define its role in opioid-sparing postoperative care.© 2026. Plastic Surgery Research Council | All rights reserved |*Source: https://ps-rc.org/meeting/Program/2026/AS111.cgi*