Postoperative opioid consumption after orthopedic surgery using sublingual patient controlled analgesia. Effects of different anesthetic techniques

Background and Aims: Acute postoperative pain after total hip arthroplasty (THA) and total knee arthroplasty (TKA) has been reported as moderateto- severe. Aim of this study was to evaluate the effects of different anesthetic techniques on post-operative analgesic opioid consumption in patients who underwent THA and TKA and received Sufentanil Sublingual Tablet System Zalviso® (SSTS) for post-operative pain. Methods: Adults aged ≥18years, who had undergone THA and TKA, received SSTS for the first 72 hours after surgery. Patients were grouped according to the kind of surgery and the type of anesthesia. THAwas performed under spinal anesthesia (SA) or general balanced anesthesia (GA). TKA was conducted under SA or single-shot peripheral nerve block (PNB). Data were collected at baseline (T0) and from day 1-3 after surgery. Results: Twenty-eight patients were included after THA (n=17; 60.7%) and TKA (n=11; 39.3%). 3 patients prematurely interrupted treatment. In THA, SA and GA were associated with a similar postoperative opioid consumption, 25.3 vs 22.5 doses respectively. Similarly, in TKA, no differenceswere observed in total opioid consumption in patients undergoing PNBs and SA, which resulted in 32.5 vs 30 doses, respectively (Figure 1). Timing for the first SSTS dose was similar in patients undergoing SA (75.9 vs 74 min, in THA and TKA respectively). Conversely, it was significantly shortened by GA in THA (27.5 min) and delayed in PNB in TKA (216.7 min).