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Stefano Turi, Francesco Deni, Gaetano Lombardi, Marilena Marmiere, Francesco Giuseppe Nisi, Luigi BerettaDipartimento di Anestesia e Rianimazione, Ospedale San Raffaele, Milano, ItalyBackground: The Sufentanil Sublingual Tablet System (SSTS) is a new, pre-programmed, noninvasive, handheld system for patient-controlled analgesia (PCA) which may allow a faster postoperative recovery compared with standard PCA. The efficacy of SSTS in controlling pain after open abdominal surgery has already been documented. However, to our knowledge SSTS has never been investigated in patients undergoing major surgery within an Enhanced Recovery After Surgery (ERAS) protocol.Methods: This observational, retrospective analysis included consecutive patients undergoing elective major abdominal and gynecological surgery. All patients received the SSTS device once they were fully awake and had a good control of pain at the end of the surgery. We analyzed changes in pain intensity according to the numerical rating scale (NRS) throughout the treatment as well as its duration, the number of administrations, and possible related adverse events. Patients were also interviewed to assess their quality of sleep and overall satisfaction with the SSTS device.Results: The study included 308 patients. Compared to the first SSTS administration, pain intensity decreased from a median NRS of 6 to 0 at day 3, for an overall reduction of 79%. Results were already statistically significant at postoperative day 1 (p

Stefano Turi, Francesco Deni, Gaetano Lombardi, Marilena Marmiere, Francesco Giuseppe Nisi, Luigi Beretta Dipartimento di Anestesia, Ospedale San Raffaele, Milano, ItalyCorrespondence: Stefano TuriDepartment of Anesthesiology, Vita-Salute, University, San Raffaele Hospital, Via Olgettina 60, Milan 20132, ItalyTel + 39 02 2 643 2656Email turi.stefano@hsr.it We thank Wang and Miao1 for their interest in our recent publication2 and the appreciation of our work. We agree with them on the need of using repeated-measures analysis to evaluate pain intensity at different timepoints. We acknowledge that, for the sake of brevity, our manuscript did not properly clarify the statistical methods used for the analysis and we take this opportunity to better explain them. We performed a repeated measure analysis of variance (ANOVA) to compare pain intensity on different time points. The analysis resulted statistically significant (p

The control of post-operative pain in Italy and other western countries is still suboptimal. In recent years, the Sufentanil Sublingual Tablet System (SSTS; Zalviso; Acel-Rx Pharmaceuticals, Redwood City, CA, USA), which is designed for patient-controlled analgesia (PCA), has entered clinical practice. SSTS enables patients to manage moderate-to-severe acute pain during the first 72 postoperative hours directly in the hospital setting. However, the role of SSTS within the current framework of options for the management of post-operative pain needs to be better established. This paper presents the position on the use of SSTS of a multidisciplinary group of Italian Experts and provides protocols for the use of this device. [ABSTRACT FROM AUTHOR]

Compares the preparation and discharge times, the side-effects and patient satisfaction after gynecological outpatient procedures performed using either spinal block or total intravenous anesthesia with propofol and remifentanil. Hysteroscopic ablation of endometrial neoplasm; Occurrence of untoward events and anesthesia-related costs; Assessment of the degree of pain using a visual analogue scale.

Compares the effects on cardiovascular changes induced by tracheal intubation with small doses of remifentanil or sufentanil in the presence of midazolam. Alteration in the systolic and diastolic arterial pressure; Effects of tracheal intubation with heart rate values; Relationship between increasing opioid dose and reducing cardiovascular response.

Summary To evaluate the effects of adding low-dose fentanyl to 0.75% ropivacaine during peripheral nerve blocks, 30 ASA physical status I–II patients undergoing hallux valgus repair under combined sciatic–femoral nerve block were randomly allocated in a double-blind fashion to receive nerve block placement with 30 mL of either 0.75% ropivacaine alone (group: ropivacaine, n = 15) or 0.75% ropivacaine plus fentanyl 1 µg kg-1 (group: ropivacaine–fentanyl, n = 15). A blinded observer recorded haemodynamic variables and sedation, as well as the time required to achieve surgical block and the first request for analgesia. Readiness to surgery required 10 min (5–20 min) with 0.75% ropivacaine and 10 min (3–20 min) with the ropivacaine–fentanyl mixture. No differences in the degree of sedation, peripheral oxygen saturation, and haemodynamic variables were observed between the two groups. The degree of pain measured at first analgesic request, and the consumption of postoperative analgesics, was similar in the two groups, while the mean time from block placement to the first request for pain medication was 13.7 h (25–75th percentiles: 11.8–14.5 h) in the ropivacaine group and 13.9 h (25–75th percentiles: 10.5–14.5 h) in the ropivacaine–fentanyl group (P = not significant). We conclude that adding fentanyl 1 µg kg-1 to 0.75% ropivacaine did not provide clinically relevant advantages in terms of onset time, quality and duration of combined sciatic–femoral nerve block in patients undergoing elective hallux valgus repair. [ABSTRACT FROM AUTHOR]