Opioids: other routes for use in recovery room.
Opioids remain the main pharmacological tools for pain control in the postoperative patient. Recent concerns about chronic use of non-steroidal anti-inflammatory drugs have put extra pressure on health care workers to device and develop new medications and delivery methods to provide patients with appropriate pain relief after surgery. New technologies and better understanding of the pharmacology of the opioids administered by non-traditional ways will be reviewed in this manuscript. Understanding the anatomy of the nose cavity is important to use the inhaled way to deliver fentanyl, sufentanyl or butorphanol in surgical patients. High concentration and small volume are keys to good absorption and effect by nasal administration. Transdermal delivery of fentanyl has been used in chronic pain for some years. A new fentanyl self-administration method is in advanced trials for clinical use. It has a huge potential in giving good pain relief with lower side effects and more patient independence because of its reduced size and lack of tubing attached to it. Day surgery patients could be great candidates for this therapeutic alternative. Finally, oral transmucosal fentanyl is also in the market. Better suited to be used in controlling breakthrough pain in chronic settings, it has been so far marketed in the perioperative period. Side effects are a concern in its use for preoperative sedation in children. Large studies are now required for drugs approval and for new indications at regulatory agencies level. Good clinical judgment is more relevant now than ever before to avoid complications and new withdraw of old good medications inappropriately prescribed from the market place.
Asenjo
Juan-Francisco
JF
Department of Anesthesia and Acute Pain Service, The Montreal General Hospital, McGill University, Montreal, Canada. jfasenjog@yahoo.com
Brecht
Krista M
KM
D000279:Administration, Cutaneous; D000281:Administration, Intranasal; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D005283:Fentanyl / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007478:Iontophoresis; D010149:Postoperative Pain / Q000188:drug therapy*; D011997:Recovery Room
D000701:Analgesics, Opioid; D005283:Fentanyl