Patient-Controlled Intranasal Analgesia

Striebel, H. W.; Oelmann, Thomas; Spies, Claudia; Rieger, Armin; Schwagmeier, R.

doi:10.1213/00000539-199609000-00019

Cited by 41 publications

(5 citation statements)

References 8 publications

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“…Most nasal devices deliver a spray volume of approximately 0.1 mL, although many studies of nasal opioids have used larger spray volumes. 1,3,4,7,25 The majority of patients experienced a bitter taste after the nasal spray, which may be explained by mucociliary clearance of hydromorphone from the nasal mucosa into the nasopharynx, or by 'runoff' of an excessive spray volume of 0.2 mL. 1,26 We believe this is the first study to evaluate the clinical effects of intranasal hydromorphone, although the study design was such that interpretation of findings should be cautious.…”

Section: Discussionmentioning

confidence: 98%

“…Fentanyl is suitable for postoperative intranasal use, showing bioavailability of approximately two-thirds compared with intravenous administration and acceptable clinical properties and patient acceptability. 3,7,8,25 Further trials of hydromorphone, preferably using devices with a lower spray volume than used in this study, should be considered.…”

Section: Discussionmentioning

confidence: 99%

“…An interest in non-invasive fast-acting modes of opioid administration has included investigation of the intranasal route, which for some drugs shows bioavailability approaching intravenous administration and which can produce similar analgesic efficacy to intravenous administration. [1][2][3][4][5][6][7][8] The rapid and reliable onset of action, avoidance of injection and ease and familiarity of administration make the intranasal route appealing for the adult and paediatric populations. 3,9 Hydromorphone, a semisynthetic drug derived from morphine, is similar in its effects to morphine and much cheaper than opioids like fentanyl.…”

Section: Introductionmentioning

confidence: 99%

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Pharmacokinetics and Bioavailability of Hydromorphone Nasal Spray

Lim

Paech

Goy

et al. 2008

Pharmacy Practice and Res

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Aim To evaluate the pharmacokinetics and bioavailability of two formulations of intranasal hydromorphone hydrochloride in adult postoperative patients. Method In an open‐label, randomised, crossover study a convenience sample of adult postoperative patients received intravenous hydromorphone 1 mg and intranasal hydromorphone 2 mg (with and without chitosan). Results Pharmacokinetic data sets from 19 patients showed intranasal hydromorphone produced detectable serum levels within 2 minutes of administration, with mean bioavailability of 49.5% (without chitosan) and 67.5% (with chitosan). Mean peak serum concentrations were 0.92 ng/mL (without chitosan) and 1.16 ng/mL (with chitosan). Summed pain intensity differences suggest that intravenous hydromorphone produced a better clinical response. Conclusion The bioavailability of intranasal hydromorphone is approximately 0.6 of intravenous hydromorphone. Adding chitosan to the intranasal solution did not significantly increase the bioavailability of hydromorphone.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pharmacokinetics and Bioavailability of Hydromorphone Nasal Spray

Lim

Paech

Goy

et al. 2008

Pharmacy Practice and Res

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“…Other PCA device concepts for various routes of administration have been suggested like reusable dispensers to take medication like liquids [26] or standard pills [27] orally, administer opioids through inhalation [28,29], or administer the drug through the nose [30,31]. ese concepts have either not gained significant market traction or have not been commercially developed yet.…”

Section: Technology: Safety As Itsmentioning

confidence: 99%

“…Sufentanil is administered in combination with a dedicated dispenser for sublingual administration [25], and fentanyl had been used in conjunction with a transdermal system [23]. Fentanyl has also been studied for intranasal administration [30,36].…”

Section: Pharmaceuticals: Fast Onset With No Adverse Events!mentioning

confidence: 99%

Quo Vadis PCA? A Review on Current Concepts, Economic Considerations, Patient-Related Aspects, and Future Development with respect to Patient-Controlled Analgesia

Nardi-Hiebl

Eberhart

Gehling

et al. 2020

Anesthesiology Research and Practice

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This review assesses four interrelating aspects of patient-controlled analgesia (PCA), a long-standing and still widely used concept for postoperative pain management. Over the years, anaesthesiologists and patients have appreciated the benefits of PCA alike. The market has seen new technologies leveraging noninvasive routes of administration and, thus, further increasing patient and staff satisfaction as well as promoting safety aspects. Pharmaceutical research focuses on the reduction or avoidance of opioids, side effects, and adverse events although influence of these aspects appears to be minor. The importance of education is still eminent, and new educational formats are tested to train healthcare professionals and patients likewise. New PCA technology can support the implementation of efficient processes to reduce workload and human errors; however, these new products come with a cost, which is not necessarily reflected through beneficial budget impact or significant improvements in patient outcome. Although first steps have been taken to better recognize the importance of postoperative pain management through the introduction of value-based reimbursement, in most western countries, PCA is not specifically compensated. PCA is still an effective and valued technique for postoperative pain management. Although there is identifiable potential for future developments in various aspects, this potential has not materialized in new products.

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The History of Opioid Use in Anesthetic Delivery

Stanley

2014

The Wondrous Story of Anesthesia

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Patient-Controlled Intranasal Analgesia

Cited by 41 publications

References 8 publications

Pharmacokinetics and Bioavailability of Hydromorphone Nasal Spray

Pharmacokinetics and Bioavailability of Hydromorphone Nasal Spray

Quo Vadis PCA? A Review on Current Concepts, Economic Considerations, Patient-Related Aspects, and Future Development with respect to Patient-Controlled Analgesia

The History of Opioid Use in Anesthetic Delivery

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