[Intranasal opioids for acute pain].
Intranasal drug administration is an easy, well-tolerated, noninvasive transmucosal route that avoids first-pass metabolism in the liver. The nasal mucosa provides an extensive, highly vascularized surface of pseudostratified ciliated epithelium. It secretes mucus that is subjected to mucociliary movement that can affect the time of contact between the drug and the surface. Absorption is influenced by anatomical and physiological factors as well as by properties of the drug and the delivery system. We review the literature on intranasal administration of fentanyl, meperidine, diamorphine, and butorphanol to treat acute pain. The adverse systemic effects are similar to those described for intravenous administration, the most common being drowsiness, nausea, and vomiting. Local effects reported are a burning sensation with meperidine and a bad taste.
Añez Simón
C
C
Servicio de Anestesiología, Reanimación y Terapéutica del Dolor y M. Paliativa, Hospital Universitario de Tarragona Joan XXIII, Tarragona. cristobal_anez@yahoo.es
Rull Bartomeu
M
M
Rodríguez Pérez
A
A
Fuentes Baena
A
A
D000042:Absorption; D000208:Acute Disease; D000281:Administration, Intranasal; D000328:Adult; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D002077:Butorphanol / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D002648:Child; D018592:Cross-Over Studies; D005283:Fentanyl / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D003932:Heroin / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D006801:Humans; D008614:Meperidine / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D009297:Nasal Mucosa / Q000201:enzymology / Q000378:metabolism; D010146:Pain / Q000188:drug therapy*; D010149:Postoperative Pain / Q000188:drug therapy; D016032:Randomized Controlled Trials as Topic
D000701:Analgesics, Opioid; D003932:Heroin; D008614:Meperidine; D002077:Butorphanol; D005283:Fentanyl