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

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

Sufentanil sublingual tablet system for enhanced recovery after total knee arthroplasty: a prospective observational case study

“…While the low number of patients may partly explain the lack of difference, no trend was visible between the two groups on other recovery parameters, such as knee flexion, pain, and length of hospitalization. These data confirm the limited interest of SSTS in accelerating rehabilitation, already observed in a very recent study which evaluated its interest in reducing pain and time to first mobilization (Noel et al 2020 ).…”

“…Pain appeared however to be effectively controlled in both groups, confirming the efficacy of SSTS for the control of postoperative pain after knee arthroplasty (Jove et al 2015 ; Meijer et al 2018 ; Melson et al 2014 ; Scardino et al 2018 ). But, although its use has been shown to be effective in treating postoperative pain in various surgeries, including major orthopedic surgery, no clinically significant difference has been observed in comparison with other usual effective analgesic techniques such as the PCA morphine so far (Noel et al 2020 ; van Veen et al 2018 ). Conversely, it has even been shown to be responsible for more side effects, in particular nausea and vomiting (Jove et al 2015 ; Noel et al 2020 ; van Veen et al 2018 ).…”

“…But, although its use has been shown to be effective in treating postoperative pain in various surgeries, including major orthopedic surgery, no clinically significant difference has been observed in comparison with other usual effective analgesic techniques such as the PCA morphine so far (Noel et al 2020 ; van Veen et al 2018 ). Conversely, it has even been shown to be responsible for more side effects, in particular nausea and vomiting (Jove et al 2015 ; Noel et al 2020 ; van Veen et al 2018 ). Even if we did not observe significantly more adverse effects of morphine, we observed in our case study a significantly higher consumption in terms of morphine equivalents.…”

A Comparative Analysis of Transitional Analgesia with Oxycodone and Sufentanil in Patients with Early Esophageal Carcinoma Undergoing Endoscopic Submucosal Dissection

“…Oxycodone also displayed e cacy in both rest and movement states, suggesting improved sleep and sedation at rest, potentially contributing to better recovery [18] . Additionally, oxycodone demonstrated superior analgesic effects in the movement state within 12 hours after surgery, facilitating early patient mobility and accelerating Enhanced Recovery After Surgery (ERAS) recovery [19] . Concerning side effects, decannulation time and recovery time were statistically signi cant in the oxycodone group compared to other groups, without causing delayed recovery.…”