Background:
In patients with end-stage glenohumeral osteoarthritis, shoulder
arthroplasty provides long-term benefits in terms of pain relief
and functionality [1]. Opioids can be part of a multimodal
approach in post-operative pain management. The sufentanil
sublingual tablet system (SSTS) is an innovative, non-invasive
patient controlled analgesia (PCA), which has been shown to be
effective in hip and knee replacement [2]. The aim of this study
is to evaluate its efficacy and safety in patients undergoing
shoulder arthroplasty.
Methods:
Adults undergoing shoulder arthroplasty under general
anesthesia received post-operative SSTS 15 mcg, with a 20-min
lockout interval, as requested for pain, over the 72-hour study
period. The primary endpoint was postoperative pain on a 11-
point numeric rating scale (NRS). Secondary endpoints were the
Patient Global Assessment (PGA) on a 5-point categorical scale
(excellent, very good, good, fair, poor), pain interference on
sleep on a 11-point Likert scale, and occurrence of side effects. 
Results:
16 patients were enrolled. Average age was 68.7 years
(SD 15.4 years), with 68.7% being over 65 years. Average
baseline pain intensity was 3.0 (SD 2.2) and it remained ≤ 2
along all the study period [Fig.1]. Required SSTS doses ranged
from 5 to 36 in 72 hours (mean 18.31) [Fig.2]. 67.7% of the
doses were required in the first 24 hours. Mean duration of
SSTS therapy was 45.7 h. 81.2% of patients and 93.7% of
caregivers evaluated the analgesia obtained with SSTS as very
good or excellent [Fig.3]. Mean pain interference with sleep was
1.67, 1.36, and 0, in the first three postoperative days. No
patients prematurely interrupted the treatment for inadequate
analgesia or side effects.
Conclusions:
SSTS was effective and well accepted by patients undergoing
shoulder arthroplasty and resulted in effective management of
moderate-to-severe acute postoperative pain.

POSTOPERATIVE ANALGESIA FOLLOWING SHOULDER ARTHROPLASTY: ROLE OF SUFENTANIL SUBLINGUAL TABLET SYSTEM