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Lindemann C, Strube P, Fisahn C, Sgroi M, Dornacher D, Zippelius T. Patient-controlled sublingual sufentanil tablet system versus intravenous opioid analgesia for postoperative pain management after lumbar spinal fusion surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:321-328. [PMID: 36472663 DOI: 10.1007/s00586-022-07462-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 10/28/2022] [Accepted: 11/07/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE This retrospective cohort study investigated the efficacy of a sublingual sufentanil tablet system (SSTS) in comparison to intravenous patient-controlled analgesia (IV-PCA) with piritramide for the management of postoperative pain following lumbar spinal fusion surgery. METHODS This was a retrospective analysis of patients undergoing single- or two-level lumbar spinal fusion surgery and receiving the SSTS or IV-PCA for postoperative pain relief as part of multimodal pain management that included IV paracetamol and oral metamizole. The following variables were collected: postoperative pain intensity and frequency scores using the numerical rating scale (NRS), hospital anxiety and depression scale (HADS), occurrence of nausea, postoperative mobilization, and patient satisfaction (MacNab criteria). RESULTS Sixty-four patients were included. Those receiving the SSTS (n = 30) had significantly lower pain intensities on the operative day (NRS: 4.0, CI: 3.6-4.3 vs. 4.5, CI: 4.2-4.9; p < 0.05) and one day postoperatively (NRS: 3.4, CI: 3.1-3.8 vs. 3.9 CI: 3.6-4.3; p < 0.05) compared to patients receiving IV-PCA (n = 34). No differences were observed on postoperative days 2 to 5. SSTS patients experienced more nausea than IV-PCA patients (p = 0.027). Moreover, SSTS patients had a higher percentage of early mobilization following surgery than IV-PCA patients (p = 0.040). Regarding patient satisfaction, no significant differences were seen between the groups. CONCLUSION The SSTS is a potentially advantageous alternative to opioid IV-PCA for use within a multimodal approach to managing postoperative pain after lumbar fusion surgery. Furthermore, the potentially higher emetic effect of SSTS should be considered, and the patient should be able to perform the application.
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Affiliation(s)
- Chris Lindemann
- Orthopedic Department, Jena University Hospital, Campus Eisenberg, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany.
| | - Patrick Strube
- Orthopedic Department, Jena University Hospital, Campus Eisenberg, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
| | - Christian Fisahn
- Orthopedic Department, Jena University Hospital, Campus Eisenberg, Klosterlausnitzer Str. 81, 07607, Eisenberg, Germany
| | - Mirco Sgroi
- Department for Orthopaedic Surgery, RKU, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Daniel Dornacher
- Department for Orthopaedic Surgery, RKU, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Timo Zippelius
- Department for Orthopaedic Surgery, RKU, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
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Angelini A, Parise GM, Cerchiaro M, Ambrosio F, Navalesi P, Ruggieri P. Sublingual Sufentanil Tablet System (SSTS-Zalviso ®) for Postoperative Analgesia after Orthopedic Surgery: A Retrospective Study. J Clin Med 2022; 11:jcm11226864. [PMID: 36431339 PMCID: PMC9698499 DOI: 10.3390/jcm11226864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/08/2022] [Accepted: 11/17/2022] [Indexed: 11/23/2022] Open
Abstract
Background: The aim of this study is to compare sublingual sufentanil and the administration device for its delivery (SSST-Zalviso®) with the traditional strategies used for the control of postoperative pain to establish if there is an actual benefit for the patient and healthcare personnel. Materials and Methods: A retrospective study was conducted to compare the efficacy of SSTS in the management of postoperative pain after orthopedic surgery between October 2018 and June 2020. We analyzed 50 patients who underwent a total knee arthroplasty (TKA). The control group consisted of 21 patients who underwent TKA and during the hospitalized recovery received a continuous femoral nerve block (cFNB). The statistical study was conducted with a level of significance p = 0.05 using “U” test, Mann−Whitney, to verify if patients had a better control of pain and fewer calls for rescue analgesia. Results: Patients involved in the study showed a significant reduction in pain intensity with the use of SSTS in the 24 h following surgery (p = 0.0568), also a drastic drop of the calls for rescue analgesia (p < 0.0001) reduces the number of calls for its control. Conclusions: This study demonstrates how SSTS might reduce pain intensity in the first 24 h after surgery and reduce the number of calls for its control, indicating better analgesic coverage and implying reduced interventions from healthcare personnel. This could allow a redistribution of resources and a reduction in the use of analgesic drugs in wards where the SSTS is used.
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Affiliation(s)
- Andrea Angelini
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padova, Italy
- Correspondence: ; Tel.: +39-04-9821-3311 or +39-33-3442-0795
| | - Gian Mario Parise
- Institute of Anesthesiology and Critical Care, Department of Medicine-DIED, University of Padova, 35128 Padova, Italy
| | - Mariachiara Cerchiaro
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padova, Italy
| | - Francesco Ambrosio
- Institute of Anesthesiology and Critical Care, Department of Medicine-DIED, University of Padova, 35128 Padova, Italy
| | - Paolo Navalesi
- Institute of Anesthesiology and Critical Care, Department of Medicine-DIED, University of Padova, 35128 Padova, Italy
| | - Pietro Ruggieri
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padova, Italy
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Rineau E, Dumartinet B, Samson E, Dollfus A, Aubourg C, Lasocki S. Sufentanil sublingual tablet system for enhanced recovery after total knee arthroplasty: a prospective observational case study. Perioper Med (Lond) 2022; 11:50. [PMID: 36195919 PMCID: PMC9531461 DOI: 10.1186/s13741-022-00284-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 09/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Postoperative pain is one of the main factors that delays recovery after prosthetic knee surgery. The use of sufentanil sublingual tablet systems (SSTS) can effectively relieve postoperative pain, but their value in facilitating early mobilization has been little studied so far. Our aim here was to assess whether their use could facilitate recovery after knee arthroplasty in an enhanced recovery program. CASE PRESENTATION In a prospective observational single-center study, thirty patients operated on for primary knee arthroplasty in the enhanced recovery pathway were included. Patients who received the SSTS (n=15) were compared with those who received an intravenous morphine patient-controlled analgesia (PCA) (n=15). Our recovery program included in particular the use of an adductor canal block, periarticular infiltration of local anesthetic by the surgeon, removal of the venous cannula from the recovery room if possible, the use of an SSTS when available or an IV morphine PCA otherwise, and early physiotherapy. Recovery parameters including the Timed-Up and Go test, pain scores at rest and on exertion, knee flexions, complications, and lengths of hospital stay were not significantly different between the two groups. However, the postoperative opioid consumption in morphine equivalents was significantly greater in the SL-sufentanil group and these patients had their venous cannula removed earlier than in IV-morphine group. CONCLUSION In our center, the use of a SSTS was suitable for treating postoperative pain after knee arthroplasty, but it did not improve early recovery in comparison with a morphine PCA.
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Affiliation(s)
- Emmanuel Rineau
- Department of Anesthesiology and Intensive Care, University Hospital and Health Faculty of the University of Angers, 4 rue Larrey, 49100, Angers, France.
| | - Benjamin Dumartinet
- Department of Anesthesiology and Intensive Care, University Hospital and Health Faculty of the University of Angers, 4 rue Larrey, 49100, Angers, France
| | - Emmanuel Samson
- Department of Anesthesiology and Intensive Care, University Hospital and Health Faculty of the University of Angers, 4 rue Larrey, 49100, Angers, France
| | - Apolline Dollfus
- Department of Anesthesiology and Intensive Care, University Hospital of Rennes, Rennes, France
| | - Corentin Aubourg
- Department of Anesthesiology and Intensive Care, University Hospital and Health Faculty of the University of Angers, 4 rue Larrey, 49100, Angers, France
| | - Sigismond Lasocki
- Department of Anesthesiology and Intensive Care, University Hospital and Health Faculty of the University of Angers, 4 rue Larrey, 49100, Angers, France
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Amson H, Lasselin P, Naegels B, Pardey Bracho GF, Aubrun F, Dziadzko M. Usability evaluation of sufentanil sublingual tablet analgesia in patients following Enhanced Recovery After Surgery. J Comp Eff Res 2021; 10:743-750. [PMID: 33880939 DOI: 10.2217/cer-2020-0239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To evaluate the usability and satisfaction from the sufentanil sublingual tablet system analgesia in the Enhanced Recovery After Surgery pathway in patients, nurses and physical therapist. Materials & methods: A system usability scale was used to evaluate analgesia system in the prospective observational study in spine, orthopedic and thoracic patients. Result: In 111 cases the median system usability scale score was 90 (80-100) (patients) and 72.5 (57.5-82.5) (nurses). The median satisfaction score of the physiotherapist was 90 (75-100). Conclusion: The usability and the satisfaction of the patients and the caregivers from sufentanil sublingual tablet system analgesia in the context of Enhanced Recovery After Surgery protocol were good-to-excellent. The economic potential in the reduction of hospital stay should be studied. Trial registration number: NCT03373851 (ClinicalTrial.gov).
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Affiliation(s)
- Harry Amson
- Département d'Anesthésie-Réanimation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard, Lyon, France
| | - Philippe Lasselin
- Département d'Anesthésie-Réanimation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard, Lyon, France
| | - Bertille Naegels
- Département d'Anesthésie-Réanimation, Hôpital Louis Pradel, Hospices Civils de Lyon, Université Claude Bernard, France
| | - Gilda F Pardey Bracho
- Département d'Anesthésie-Réanimation, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Université Claude Bernard, France
| | - Frédéric Aubrun
- Département d'Anesthésie-Réanimation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard, Lyon, France.,U1290 RESHAPE, Université Claude Bernard Lyon 1, INSERM, Lyon, France
| | - Mikhail Dziadzko
- Département d'Anesthésie-Réanimation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard, Lyon, France.,U1290 RESHAPE, Université Claude Bernard Lyon 1, INSERM, Lyon, France
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Noel E, Miglionico L, Leclercq M, Jennart H, Fils JF, Van Rompaey N. Sufentanil sublingual tablet system versus oral oxycodone for management of postoperative pain in enhanced recovery after surgery pathway for total knee arthroplasty: a randomized controlled study. J Exp Orthop 2020; 7:92. [PMID: 33216238 PMCID: PMC7679427 DOI: 10.1186/s40634-020-00306-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/02/2020] [Indexed: 11/21/2022] Open
Abstract
PURPOSE Effectiveness of sufentanil sublingual tablet system (SSTS) compared to oral oxycodone in the management of postoperative pain after total knee arthroplasty (TKA) within an enhanced recovery after surgery (ERAS) protocol. METHODS This pragmatic, parallel, open label, randomized controlled, trial enrolled 72 adult patients scheduled for TKA under spinal anesthesia following ERAS pathway. In addition to multimodal analgesia, patients received SSTS 15 mcg (SSTS group) or oral oxycodone extended release 10 mg twice daily and oral oxycodone immediate-release 5 mg up to four times daily on demand (Oxy group) to control pain during 48 h postoperatively. The primary endpoint was pain measured using a numeric rating scale at 24 h postoperatively. Time to first mobilization, side effects and patient satisfaction were also recorded. RESULTS Median pain score at 24 h at rest was 3 [2-4] for Oxy group vs 2 [1.75-3] for SSTS group (p = 0.272) whereas median pain score on movement was 4 [3-6] vs 3 [2-5] respectively (p = 0.059). No difference in time to first mobilization was found between the two groups. The method of pain control was judged good/excellent for 83.9% of patients in the SSTS group compared with 52.9% in the Oxy group (p = 0.007). The incidence of nausea was 33% in SSTS group and 9% in Oxy group (p = 0.181). CONCLUSIONS In complement to ERAS multimodal analgesia, sublingual sufentanil 15 mcg tablet system did not show clinically significant pain improvement compared to oral oxycodone after total knee arthroplasty. TRIAL REGISTRATION Clinical Trials: NCT04448457 ; retrospectively registered on June 24, 2020. https://clinicaltrials.gov/ct2/show/NCT04448457?cond=sublingual+sufentanil&cntry=BE&draw=2&rank=3.
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Affiliation(s)
- Emmanuel Noel
- Anesthesiology, CHU Tivoli Hospital, Avenue Max Buset, 34, 7100, La Louvière, Belgium.
| | - Luca Miglionico
- Anesthesiology, CHU Tivoli Hospital, Avenue Max Buset, 34, 7100, La Louvière, Belgium
| | - Mickael Leclercq
- Anesthesiology, CHU Tivoli Hospital, Avenue Max Buset, 34, 7100, La Louvière, Belgium
| | - Harold Jennart
- Orthopedic surgery, CHU Tivoli Hospital, La Louvière, Belgium
| | | | - Nicolas Van Rompaey
- Anesthesiology, CHU Tivoli Hospital, Avenue Max Buset, 34, 7100, La Louvière, Belgium
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Patient-Controlled Analgesia in High-Risk Populations: Implications for Safety. CURRENT ANESTHESIOLOGY REPORTS 2020. [DOI: 10.1007/s40140-020-00406-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Porela-Tiihonen S, Kokki H, Kokki M. An up-to-date overview of sublingual sufentanil for the treatment of moderate to severe pain. Expert Opin Pharmacother 2020; 21:1407-1418. [DOI: 10.1080/14656566.2020.1766025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Susanna Porela-Tiihonen
- Department of Anaesthesia and Operative Services, Kuopio University Hospital , Kuopio, Finland
| | - Hannu Kokki
- Department of Anaesthesia and Operative Services, Kuopio University Hospital , Kuopio, Finland
| | - Merja Kokki
- Department of Anaesthesia and Operative Services, Kuopio University Hospital , Kuopio, Finland
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Giaccari LG, Coppolino F, Aurilio C, Esposito V, Pace MC, Paladini A, Passavanti MB, Pota V, Sansone P. Sufentanil Sublingual for Acute Post-Operative Pain: A Systematic Literature Review Focused on Pain Intensity, Adverse Events, and Patient Satisfaction. Pain Ther 2020; 9:217-230. [PMID: 32303979 PMCID: PMC7203368 DOI: 10.1007/s40122-020-00166-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Indexed: 12/16/2022] Open
Abstract
CONTEXT Pain is commonly experienced among patients after surgical procedures. Clinical pain management after surgery is far from being successful. Patients may control postoperative pain by self-administration of intravenous opioids using devices designed for this purpose (patient-controlled analgesia or PCA). PCA devices have been developed including the sufentanil sublingual tablet system (SSTS). A systematic review of the use of SSTS for postoperative pain is needed to identify an alternative method of pain management. OBJECTIVES To systematically review literature to establish the efficacy and the safety of PCA with SSTS used in the treatment of moderate-to-severe acute post-operative pain in a hospital setting. METHODS Embase, MEDLINE, Google Scholar, and Cochrane Central Trials Register were systematically searched in December 2019 for studies examining SSTS for pain in adult after surgical procedures. The methodological quality of the studies and their results were appraised using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist and specific measurement properties criteria, respectively. RESULTS Sixteen studies evaluating SSTS were included for a total of 2311 patients. All participants in the SSTS group reported NRS ≤ 4 within 24 h after surgery. Patient satisfaction was high, with a minimum of 70% satisfaction among patients treated with SSTS. The most common adverse events (AEs) overall for SSTS 15 and 30 mcg were nausea, vomiting, and headache. AEs observed in the studies were generally consistent with those associated with opioids and the postsurgical setting. CONCLUSIONS SSTS is an important system for the management of moderate-to-severe acute pain in a hospital setting. SSTS is well tolerated, with no unexpected adverse events (AEs) and no clinically meaningful vital sign changes. These data confirm the safety and tolerability of the SSTS. Successful pain management resulted in a high level of acceptance of the SSTS by patients with high satisfaction for the method of pain control.
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Affiliation(s)
- Luca G Giaccari
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Coppolino
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Caterina Aurilio
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Valentina Esposito
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Maria Caterina Pace
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Maria Beatrice Passavanti
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Vincenzo Pota
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Pasquale Sansone
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy.
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Abstract
Each month, subscribers to The Formulary Monograph Service receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation/medication use evaluation (DUE/MUE) is also provided each month. With a subscription, the monographs are available online to subscribers. Monographs can be customized to meet the needs of a facility. Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. For more information about The Formulary Monograph Service, contact Wolters Kluwer customer service at 866-397-3433.
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