Pharmacokinetics of intranasal fentanyl in parturient

Kokki, Merja; Heikkinen, Aki T.; Raatikainen, Kaisa; Ranta, Veli‐Pekka; Hautajärvi, Heidi; Kokki, Hannu

doi:10.1093/bja/aev313

Cited by 4 publications

(3 citation statements)

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“…In that study, a two-fold increase in pain scores was recorded during drain removal and this response was similar to that observed in patients administered intranasal placebo. The mean C max fentanyl concentration was 0.22 ng/mL, similar to that reported in a parturient woman after a single intranasal fentanyl 50-µg dose [ 8 ]. These concentrations are two- to three-fold less than the MEC of fentanyl 0.5 ng/mL [ 29 ].…”

Section: Discussionsupporting

confidence: 81%

“…Intranasal fentanyl has a reported high bioavailability of 71%, maximum concentration in plasma is reached within 7 min of administration and the duration of action is approximately an hour [7]. Intranasal fentanyl has been used also in noncancer acute pain [8,9]. Intravenous (IV) opioid analgesics (e.g., oxycodone) are commonly used after cardiac surgery via a patient-controlled analgesia (PCA) pump as oral absorption of drugs is unpredictable during the first 48 h after surgery [10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

“…However, patient attachment to a PCA pump can limit mobility. Thus, transmucosal administration of fentanyl is an attractive non-invasive alternative for breakthrough pain in the early postoperative period [ 6 , 8 , 9 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Intranasal Fentanyl for Intervention-Associated Breakthrough Pain After Cardiac Surgery

et al. 2021

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Background Cardiac bypass surgery patients have early postoperative interventions that elicit breakthrough pain. We evaluated the use of intranasal fentanyl for breakthrough pain management in these patients. Methods Multimodal analgesia (paracetamol 1 g three times a day, oxycodone 2-3 mg boluses with a patient-controlled intravenous pump) was used in 16 patients (age 49-70 years, weight 59-129 kg) after cardiac bypass surgery. Intranasal fentanyl 100 µg or 200 µg was used to manage breakthrough pain on the first and third postoperative mornings in a randomised order. Blood samples were collected for up to 3 h after fentanyl administration, pain was assessed with a numeric rating scale of 0-10. Plasma fentanyl concentration was assayed using liquid chromatography-mass spectrometry. Body composition was measured with a bioelectrical impedance device. Results Bioavailability of intranasal fentanyl was high (77%), absorption half-time short (< 2 min) and an analgesic plasma concentration ≥ 0.5 ng/mL was achieved in 31 of 32 administrations. Fentanyl exposure correlated inversely with skeletal muscle mass and total body water. Fentanyl analgesia was effective both on the first postoperative morning with chest pleural tube removal and during physiotherapy on the third postoperative morning. The median time of subsequent oxycodone administration was 1.1 h after intranasal fentanyl 100 µg and 2.1 h after intranasal fentanyl 200 µg, despite similar oxycodone concentrations (median 13.8, range 5.2-35 ng/mL) in both fentanyl dose groups. Conclusions Intranasal fentanyl 100 µg provided rapid-onset analgesia within 10 min and is an appropriate starting dose for incidental breakthrough pain in the first 3 postoperative days after cardiac bypass surgery.

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Section: Discussionsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

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Intranasal Fentanyl for Intervention-Associated Breakthrough Pain After Cardiac Surgery

et al. 2021

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An up-to-date overview of sublingual sufentanil for the treatment of moderate to severe pain

Porela‐Tiihonen

Kokki

2020

Expert Opinion on Pharmacotherapy

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Sufentanil sublingual formulation for the treatment of acute, moderate to severe postoperative pain in adult patients

Porela‐Tiihonen

Kokki

2016

Expert Review of Neurotherapeutics

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Sufentanil is a highly selective µ-opioid agonist commonly used by intravenous and intrathecal routes for acute pain. Sublingual sufentanil formulation for patient controlled analgesia (PCA) uses an innovative administration device that suspends a 15 µg nanotablet with a fixed lockout interval. The system is a non-invasive, less burdensome method of opioid delivery compared to intravenous and intrathecal routes. Sublingual nanotablet PCA transmucosal bioavailability is 59% and the meaningful analgesic onset time is 60 minutes. Areas covered: This paper focuses on the effectiveness, safety and feasibility of sufentanil PCA sublingual formulation for the management of postoperative pain. The paper is based on PubMed searches and the European Medicine Agency assessment report. Expert commentary: Under-treatment of acute pain is a substantial clinical problem. The initial experiences with the sublingual delivery system are encouraging. Sufentanil sublingual nanotablets intended for PCA device use are approved in Europe, and approval is pending in the United States.

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Pharmacokinetics of intranasal fentanyl in parturient

Abstract: The Baska Maska new concept in selfsealing membrane cuff extraglottic airway devices using a sump and two gastric drains. A clinical evaluation.

Cited by 4 publications

References 3 publications

Intranasal Fentanyl for Intervention-Associated Breakthrough Pain After Cardiac Surgery

Intranasal Fentanyl for Intervention-Associated Breakthrough Pain After Cardiac Surgery

An up-to-date overview of sublingual sufentanil for the treatment of moderate to severe pain

Sufentanil sublingual formulation for the treatment of acute, moderate to severe postoperative pain in adult patients

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