Opioid-sparing Analgesia with Perioperative Suzetrigine in Head and Neck Free Flap Surgery

Introduction: Postoperative pain after head and neck free flap reconstruction often requires opioids, increasing the risk of adverse effects. Opioid-sparing strategies are emphasized. Suzetrigine (Journavx) is a novel non-opioid analgesic that may reduce opioid requirements while maintaining pain control. This study evaluated postoperative opioid use and pain scores with or without adjunctive suzetrigine.

Methods: A retrospective review was conducted on patients undergoing head and neck free flap reconstruction from October to December 2025 at a tertiary center. Patients were stratified by suzetrigine use. Opioid and non-opioid analgesic administration and pain scores were recorded. Opioid doses were converted to morphine milligram equivalents (MME). Outcomes included cumulative and daily MME, pain trends, outpatient prescriptions/refills, and communications regarding pain control. All patients prescribed outpatient suzetrigine used a savings card to offset cost.

Results: 16 patients were included; 10 received suzetrigine. Median cumulative opioid use POD 1–3 was 34.3 MME (range 0–196) with suzetrigine vs. 42.0 MME (0.8–219.6) without. Median daily MME decreased from 16.3 MME on POD 1 to 5.8 MME on POD 3 (64.6% reduction) with suzetrigine vs. 14.3 MME to 10.5 MME (26.3% reduction) without. Pain control remained comparable, with no significant difference in maximum reported pain scores (POD 1 p=0.798, POD 3 p=0.437). 8 of 10 suzetrigine patients were discharged with suzetrigine prescriptions; all patients received oxycodone. 3 suzetrigine-naive patients requested oxycodone refills, and two contacted providers regarding pain, whereas no suzetrigine patients required refills or reported pain issues.

Conclusions: Adjunctive suzetrigine was associated with lower opioid use, greater perioperative reduction in daily opioid consumption, and maintained pain control, with fewer opioid refills and pain-related communications. These findings support suzetrigine as a component of multimodal opioid-sparing analgesia in head and neck reconstruction.