Patient-controlled intranasal analgesia (PCINA) for the management of postoperative pain: a pilot study

Striebel, H. W.; Olmann, Thomas; Spies, Claudia; Brummer, G.

doi:10.1016/0952-8180(95)00167-0

Cited by 85 publications

(33 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Patient-controlled intranasal analgesia with fentanyl is an effective alternative to iv patient-controlled analgesia in postoperative patients. 5,6 Helmers et al 7 have shown that sufentanil, which is two times more lipid soluble than fentanyl, is rapidly and effectively absorbed from the human nasal mucosa, with a bioavailability of 78%. However, most studies have evaluated its use for premedication or sedation using the IN route, and not for postoperative analgesia.…”

Section: Resultsmentioning

confidence: 99%

Intranasal sufentanil is effective for postoperative analgesia in adults

Mathieu¹,

Cnudde²,

Engelman³

et al. 2006

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Purposes:The aim of this prospective, randomized, doubleblind study was to compare two doses of intranasal sufentanil for postoperative analgesia, titrated according to individual requirements based upon a numeric rating scale (NRS) from 0 to 10 for pain.Methods: Forty patients, American Society of Anesthesiologists physical status I-II, scheduled for herniorrhaphy or hemorrhoidectomy under general anesthesia, were included when postoperative NRS was > 3. Nurses used a nasal puff device delivering a constant volume. Patients were randomized into two groups: Group A patients received a dose of 0.025 µg·kg -1 /puff, Group B patients a dose of 0.05 µg·kg -1 /puff. Puffs were administered as often as needed to obtain NRS ≤ 3, with an interval time of five minutes. Hemodynamic, respiratory measures and sedation were recorded every five minutes. Results:The probability of persistence of pain in Group B was consistently lower than in Group A. After 20 min, 20% of the patients had a NRS score > 3 in Group B, as opposed to 60% in Group A. At 60 min, no patient had a NRS > 3 in Group B, whereas there was a probability of 20% to record a NRS > 3 for Group A. Hemodynamic, respiratory parameters and sedation remained stable with no intergroup differences.Conclusions: Nasal administration of 0.050 µg·kg -1 /puff sufentanil allowed a NRS < 4 to be attained within one hour in all patients, with efficacy achieved after 20 min. These findings suggest that the intranasal route is an effective mode of sufentanil administration for immediate postoperative analgesia in adult patients. Objectif

show abstract

Section: Resultsmentioning

confidence: 99%

Intranasal sufentanil is effective for postoperative analgesia in adults

Mathieu¹,

Cnudde²,

Engelman³

et al. 2006

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

show abstract

“…67 In the postoperative setting, fentanyl PCINA delivery using a Baxter PCA pump (Deerfield, Illinois) (modified with an adaptor for IN administration) was found to be superior to ward-provided therapy (pethidine, tramadol, metamizole, acetaminophen, codeine, and diclofenac, used either alone or in combination) in a pilot crossover study (N ϭ 20). 68 Patients receiving PCINA had significantly lower pain scores than patients who received ward-provided therapy and patient satisfaction was greater with PCINA than with ward-provided therapy (P Ͻ .0005). 68 A single-center, crossover pilot study compared the efficacy and safety of an IN, patient-controlled, spray bottle that did not require a pump to that of IV fentanyl administration for the treatment of acute pain following gynecologic surgery.…”

Section: Patient-controlled Intranasal Analgesia (Pcina)mentioning

confidence: 92%

“…68 Patients receiving PCINA had significantly lower pain scores than patients who received ward-provided therapy and patient satisfaction was greater with PCINA than with ward-provided therapy (P Ͻ .0005). 68 A single-center, crossover pilot study compared the efficacy and safety of an IN, patient-controlled, spray bottle that did not require a pump to that of IV fentanyl administration for the treatment of acute pain following gynecologic surgery. 69 In that study, 50 g of fentanyl was delivered per spray using the IN spray device or per infusion using fentanyl delivered via IV administration.…”

Section: Patient-controlled Intranasal Analgesia (Pcina)mentioning

confidence: 92%

Patient-Controlled Drug Delivery for Acute Postoperative Pain Management: A Review of Current and Emerging Technologies

Viscusi¹

2008

Regional Anesthesia and Pain Medicine

View full text Add to dashboard Cite

Postoperative pain management has dramatically improved with the advent of patient-controlled analgesia (PCA) delivery. The optimal PCA system would encompass several key characteristics, including consistent efficacy across a number of surgeries; safety of both the analgesic drug delivered and the delivery system; ease of setup, maintenance, and administration; patient comfort during analgesic delivery; avoidance of analgesic gaps; minimal invasiveness; and it would be associated with high patient satisfaction. Existing PCA modalities (using intravenous or epidural routes) encompass some of these characteristics (e.g., they have demonstrated efficacy across a number of surgeries); however, they are limited by the need for an indwelling catheter and the time and resources required for system setup and use. Device programming-related medication errors by hospital staff are an unfortunate risk, and could lead to significant harm. New PCA technologies are on the horizon that address some of the limitations to existing modalities; however, the added complexity of these newer systems are a concern, and their benefits and drawbacks remain to be assessed. These technologies include "smart" intravenous PCA infusion pumps to improve the safety of analgesic administration; needle-free options, such as the fentanyl HCl iontophoretic transdermal system for transdermal delivery; and a number of PCA devices for intranasal delivery, as well as several new options for patient-controlled regional analgesia. This review will discuss the benefits and drawbacks of both existing and emerging PCA modalities in the context of the ideal PCA system, and provide a critical evaluation of their use in postoperative settings.

show abstract

“…Fast-release morphine (as drops or syrup) performs as well as fentanyls by noninvasive application modes, e.g. nasal spray (PCINA with fentanyl, alfentanil and pethidine [14]) or oral mucosal resorption (fentanyl lollipops). Oral bioavailability, which is generally rather low, is only a minor problem with most methadone or morphine preparations.…”

Section: Which Drug?mentioning

confidence: 99%