Sublingual sufentanil tablet system useful option to opioid IV-PCA for managing pain after lumbar fusion surgery

Postoperative pain after spinal surgery is still a significant problem that is far from being successfully managed. Patients with suboptimal pain management may develop chronic pain after surgery, less satisfaction, increased length of hospital stay and decreased mobility due to postoperative pain. Early mobilization is a crucial factor in improving postoperative recovery. Therefore, postoperative pain management needs to be optimized without restrictions.

Compared to IV-PCA, the SSTS, due to its noninvasive design, avoids the risk of pump-programming errors and other complications (e.g., infections and analgesic gaps). It also imposes less restriction on postoperative mobility.

Chris Lindemann et al conducted a retrospective cohort study to investigate 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.

The study has been published in ‘European Spine Journal.’

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).

Key findings of the study:

• 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.

The authors concluded that - the SSTS provides an effective and potentially advantageous alternative to IV-PCA with opioids for use as part of a multimodal approach to managing postoperative pain after lumbar fusion surgery. Given the potentially higher emetic effect of SSTS, the implementation of antiemetic prophylaxis should be considered. Future studies should ideally focus on evaluating the cost effectiveness of the SSTS relative to opioid-based IV-PCA.

Further reading:

Patient controlled sublingual sufentanil tablet system versus intravenous opioid analgesia for postoperative pain management after lumbar spinal fusion surgery

Chris Lindemann, Patrick Strube et al European Spine Journal https://doi.org/10.1007/s00586-022-07462-x