Background and aims Patient-controlled epidural analgesia (PCEA) in laparoscopic segmental colectomy has been questioned within the context of enhanced recovery after surgery (ERAS)¹. The aim of this retrospective cohort analysis was to evaluate postoperative analgesia and adverse effects of the sufentanil sublingual tablet system (SSTS) compared to PCEA, in patients undergoing laparoscopic segmental colectomy for inflammatory bowel disease (IBD).

Methods Following the ethical committee’s approval, we performed a retrospective before-after study comparing SSTS to PCEA in consecutive patients who underwent laparoscopic segmental colectomy for IBD. SSTS was continued until post-operative day (POD) 2, PCEA was replaced by on demand parenteral opioids on the morning of POD 1. Both groups received systematic acetaminophen. Patients with surgical complications were excluded. Records were reviewed for reported numerical rating scale for pain (NRS), postoperative nausea and vomiting (PONV), postoperative ileus (POI) until POD 2, and length of stay.

Results Maximum NRS on POD 1 was significantly reduced in the SSTS-group (n=28) compared to the PCEA-group (n=29) (mean 4.89 vs 6.45, p=0.001). Additionally, the incidence of NRS ≥7 on POD 1 was reduced (p<0.001) in the SSTS-group. NRS scores on POD 2, American Society of Anesthesiologists Classification, age, gender, amount of NRS assessments, length of stay (p=0.542), PONV (p=0.647) and POI (p=0.322) were comparable.

Conclusions SSTS seems to reduce experienced postoperative pain in patients after laparoscopic segmental colectomy for IBD. Suboptimal transition from PCEA to non-patient controlled parenteral opioids may explain the unfavorable comparison to SSTS. Prospective trials are warranted to further evaluate the role of SSTS and PCEA in ERAS.