DIE INTRANASALE OPIOIDGABE ZUR THERAPIE VON SCHMERZEN - EIN NEUER APPLIKATIONSWEG

H.W. Striebel, A. Kopf, M. Hölzl and R. Schwagmeier

Anästhesiologie & Intensivmedizin 3 (37), 128-134, 1996

 Summary: Pain management is still a neglected field, and most patients as well as many doctors are not satisfied with the current practice. In the last few years, there has been an intensive search for alternative modes of opioid administration in pain management. The intranasal mode of opioid administration seems to be an attractive alternative, especially in patients having no intravenous access. Pharmacokinetic studies have demonstrated a high bioavailability (71%, 65%, 78%) and a rapid rise in plasma concentrations (Cmax after 5-10 min) following intranasal fentanyl, alfentanil and sufentanil.

Several prospective, randomized and double-blind studies have shown pain relief to be nearly as fast and effective with demand-adapted intranasal fentanyl titration as with intravenous titration.

Patient acceptance is comparable for intranasal fentanyl titration and intravenous opioid titration. Fentanyl does not irritate the nasal or pharyngeal mucosa.

A device recently introduced for patient-controlled intranasal analgesia (PCINA) was found to provide the same safety as a conventional PCA device for intravenous titration. Recent comparative studies have demonstrated that PCINA is just as effective as intravenous PCA in the setting of postoperative pain management. Intranasal opioid titration also seems suitable for the management of breakthrough cancer pain.

PCINA appears to be a promising alternative in the management of postoperative pain as well as breakthrough cancer pain.