Sublingual sufentanil tablet system Zalviso® for postoperative analgesia after knee replacement in fast track surgery: a pilot observational study
Abstract Background Currently many TKA protocols rely on multimodal analgesic protocols with patient-controlled analgesia systems that administer opioids through a patient controlled IV infusion pump, in addition to concomitant peripheral nerve blocks and local anesthetics. Although effective, PCA I...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2018-03-01
|
| Series: | Journal of Experimental Orthopaedics |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s40634-018-0123-y |
| _version_ | 1797225683270762496 |
|---|---|
| author | Marco Scardino Tiziana D’Amato Federica Martorelli Giorgia Fenocchio Vincenzo Simili Berardo Di Matteo Dario Bugada Elizaveta Kon |
| author_facet | Marco Scardino Tiziana D’Amato Federica Martorelli Giorgia Fenocchio Vincenzo Simili Berardo Di Matteo Dario Bugada Elizaveta Kon |
| author_sort | Marco Scardino |
| collection | DOAJ |
| description | Abstract Background Currently many TKA protocols rely on multimodal analgesic protocols with patient-controlled analgesia systems that administer opioids through a patient controlled IV infusion pump, in addition to concomitant peripheral nerve blocks and local anesthetics. Although effective, PCA IV opioids do not provide optimal results with fast track rehabilitation protocols. Methods The present is a retrospective study comparing the novel sublingual sufentanil PCA system (SSTS) to our standard of care foreseeing continuous femoral nerve block (cFNB) within a multimodal analgesic in a TKA fast-track protocol. The study evaluated 95 patients on SSTS (SSTS group) and 87 on cFNB (cFNB/control group) and collected data on numeric rating scores for pain from day 1–3 after surgery (T1, T2, T3), both at rest (NRS) and during movement (mNRS), patient’s ability to walk, need for supplementary analgesia (rescue dose), occurrence of adverse effects, length of hospital stay, and usability rating for SSTS by both patients and hospital staff. Results NRS at rest was lower in the cFNB than in the SSTS group for all 3 days after surgery, whereas mNRS scores were lower in the SSTS group at all time points measured. Adverse effects were significantly fewer among patients of the SSTS group (6% patients) than those of the cFNB (74% patients) (p < 0.001). Rescue doses were needed by 5% of SSTS patients vs 60% of cFNB. The fewer adverse events and lower pain scores for the SSTS group were associated to a notably better ability to ambulate, with all patients (100%) of the SSTS group being able to stand and walk for 10 m from T1 on; patients in the cFNB group showed a slower recovery with only 40% being able to stand and walk on T1, 70% on T2 and 85% on T3. All patients of the SSTS group had a length of stay of 4 days (day of surgery plus 3 after) as foreseen by the fast track protocol, in comparison only 36% of cFNB. Lastly, patient and nursing staff judged SSTS easy to use. Conclusion Our experience suggests that SSTS is a valuable strategy for routine postoperative analgesia following TKA in the context of a multimodal analgesic approach within the fast-track setting. |
| first_indexed | 2024-03-08T08:35:19Z |
| format | Article |
| id | doaj.art-5fe48cdb53ff4b76807fc5be9cf636af |
| institution | Directory Open Access Journal |
| issn | 2197-1153 |
| language | English |
| last_indexed | 2024-04-24T14:12:54Z |
| publishDate | 2018-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Experimental Orthopaedics |
| spelling | doaj.art-5fe48cdb53ff4b76807fc5be9cf636af2024-04-03T08:59:08ZengWileyJournal of Experimental Orthopaedics2197-11532018-03-01511810.1186/s40634-018-0123-ySublingual sufentanil tablet system Zalviso® for postoperative analgesia after knee replacement in fast track surgery: a pilot observational studyMarco Scardino0Tiziana D’Amato1Federica Martorelli2Giorgia Fenocchio3Vincenzo Simili4Berardo Di Matteo5Dario Bugada6Elizaveta Kon7Department of Anesthesia, Humanitas Research HospitalDepartment of Anesthesia, Humanitas Research HospitalDepartment of Anesthesia, Humanitas Research HospitalDepartment of Anesthesia, Humanitas Research HospitalDepartment of Anesthesia, Humanitas Research HospitalCenter for functional and biologic reconstruction of the Knee, Humanitas Clinical and Research InstituteDepartment of Medicine and Surgery, Parma UniversityCenter for functional and biologic reconstruction of the Knee, Humanitas Clinical and Research InstituteAbstract Background Currently many TKA protocols rely on multimodal analgesic protocols with patient-controlled analgesia systems that administer opioids through a patient controlled IV infusion pump, in addition to concomitant peripheral nerve blocks and local anesthetics. Although effective, PCA IV opioids do not provide optimal results with fast track rehabilitation protocols. Methods The present is a retrospective study comparing the novel sublingual sufentanil PCA system (SSTS) to our standard of care foreseeing continuous femoral nerve block (cFNB) within a multimodal analgesic in a TKA fast-track protocol. The study evaluated 95 patients on SSTS (SSTS group) and 87 on cFNB (cFNB/control group) and collected data on numeric rating scores for pain from day 1–3 after surgery (T1, T2, T3), both at rest (NRS) and during movement (mNRS), patient’s ability to walk, need for supplementary analgesia (rescue dose), occurrence of adverse effects, length of hospital stay, and usability rating for SSTS by both patients and hospital staff. Results NRS at rest was lower in the cFNB than in the SSTS group for all 3 days after surgery, whereas mNRS scores were lower in the SSTS group at all time points measured. Adverse effects were significantly fewer among patients of the SSTS group (6% patients) than those of the cFNB (74% patients) (p < 0.001). Rescue doses were needed by 5% of SSTS patients vs 60% of cFNB. The fewer adverse events and lower pain scores for the SSTS group were associated to a notably better ability to ambulate, with all patients (100%) of the SSTS group being able to stand and walk for 10 m from T1 on; patients in the cFNB group showed a slower recovery with only 40% being able to stand and walk on T1, 70% on T2 and 85% on T3. All patients of the SSTS group had a length of stay of 4 days (day of surgery plus 3 after) as foreseen by the fast track protocol, in comparison only 36% of cFNB. Lastly, patient and nursing staff judged SSTS easy to use. Conclusion Our experience suggests that SSTS is a valuable strategy for routine postoperative analgesia following TKA in the context of a multimodal analgesic approach within the fast-track setting.http://link.springer.com/article/10.1186/s40634-018-0123-yFast trackTotal knee arthroplastySublingual sufentanil tablet systemContinuous femoral nerve blockZalviso® |
| spellingShingle | Marco Scardino Tiziana D’Amato Federica Martorelli Giorgia Fenocchio Vincenzo Simili Berardo Di Matteo Dario Bugada Elizaveta Kon Sublingual sufentanil tablet system Zalviso® for postoperative analgesia after knee replacement in fast track surgery: a pilot observational study Journal of Experimental Orthopaedics Fast track Total knee arthroplasty Sublingual sufentanil tablet system Continuous femoral nerve block Zalviso® |
| title | Sublingual sufentanil tablet system Zalviso® for postoperative analgesia after knee replacement in fast track surgery: a pilot observational study |
| title_full | Sublingual sufentanil tablet system Zalviso® for postoperative analgesia after knee replacement in fast track surgery: a pilot observational study |
| title_fullStr | Sublingual sufentanil tablet system Zalviso® for postoperative analgesia after knee replacement in fast track surgery: a pilot observational study |
| title_full_unstemmed | Sublingual sufentanil tablet system Zalviso® for postoperative analgesia after knee replacement in fast track surgery: a pilot observational study |
| title_short | Sublingual sufentanil tablet system Zalviso® for postoperative analgesia after knee replacement in fast track surgery: a pilot observational study |
| title_sort | sublingual sufentanil tablet system zalviso r for postoperative analgesia after knee replacement in fast track surgery a pilot observational study |
| topic | Fast track Total knee arthroplasty Sublingual sufentanil tablet system Continuous femoral nerve block Zalviso® |
| url | http://link.springer.com/article/10.1186/s40634-018-0123-y |
| work_keys_str_mv | AT marcoscardino sublingualsufentaniltabletsystemzalvisoforpostoperativeanalgesiaafterkneereplacementinfasttracksurgeryapilotobservationalstudy AT tizianadamato sublingualsufentaniltabletsystemzalvisoforpostoperativeanalgesiaafterkneereplacementinfasttracksurgeryapilotobservationalstudy AT federicamartorelli sublingualsufentaniltabletsystemzalvisoforpostoperativeanalgesiaafterkneereplacementinfasttracksurgeryapilotobservationalstudy AT giorgiafenocchio sublingualsufentaniltabletsystemzalvisoforpostoperativeanalgesiaafterkneereplacementinfasttracksurgeryapilotobservationalstudy AT vincenzosimili sublingualsufentaniltabletsystemzalvisoforpostoperativeanalgesiaafterkneereplacementinfasttracksurgeryapilotobservationalstudy AT berardodimatteo sublingualsufentaniltabletsystemzalvisoforpostoperativeanalgesiaafterkneereplacementinfasttracksurgeryapilotobservationalstudy AT dariobugada sublingualsufentaniltabletsystemzalvisoforpostoperativeanalgesiaafterkneereplacementinfasttracksurgeryapilotobservationalstudy AT elizavetakon sublingualsufentaniltabletsystemzalvisoforpostoperativeanalgesiaafterkneereplacementinfasttracksurgeryapilotobservationalstudy |