Sublingual Sufentanil: A Review in Acute Postoperative Pain

Abstract

The sufentanil sublingual tablet system (SSTS; Zalviso(®)) is a novel patient-controlled analgesia (PCA) device intended to overcome some of the drawbacks of opioid-based intravenous PCA (IV-PCA). Based on the results of three phase III studies, the SSTS has been approved in the EU for the management of acute moderate to severe postoperative pain in adults in a hospital setting. In a head-to-head comparison with morphine, the gold standard for opioid-based IV-PCA, the SSTS was associated with a more rapid onset of analgesia and higher rates of success, based on patient and healthcare professional global assessments of the method of pain control. Patients and healthcare professionals also rated the SSTS as being easier to use and expressed a greater level of overall satisfaction with this device. The SSTS was generally well tolerated, with an adverse event profile typical of that of other opioids and generally similar to that of placebo. By virtue of its preprogrammed, noninvasive design, the SSTS avoids the risk of pump programming errors and other complications (e.g. infections and analgesic gaps) that can occur with IV-PCA technology; it also imposes less restriction on postoperative mobility. As such, the SSTS provides an effective alternative to opioid-based IV-PCA for the management of acute moderate to severe postoperative pain. Future studies should ideally focus on evaluating the relative cost effectiveness of the SSTS and comparing it with other available needle-free PCA modalities.

Comparison of Cardiovascular, Analgesic and Sedative Effects of Different Doses of Dezocine

“…A recent study conducted in a cohort of adult surgical patients in the United States reveals that 86% experience pain after surgery, of which 75% have moderate-tosevere pain in the immediate postoperative period [12]. Currently, despite the increasing use of a variety of different analgesic strategies, opioids continue as the mainstay for management of moderate to severe acute pain after surgery [13,14], their analgesic effects are offset by undesired adverse effects, including RD, drug addiction, and PONV [15][16][17]. What merits our primary concern is that opioids inducing PONV and RD is the most common side effect for acute postoperative pain.…”

Between evidence and commerce – the case of sufentanil sublingual tablet systems

“…Further, looking through the retrieved titles of the Pubmed search, we were surprised to find seven review articles published between November 2015 and February 2017 regarding the use of sublingual sufentanil nanotablets for the treatment of pain 14, 15, 16, 17, 18, 19, 20. All seven reviews included the same original articles, sometimes citing each other 14, 15, 18, 19 or providing the same figures 14, 17, 19 or similar tables 14, 17, 19.…”

“…All seven reviews included the same original articles, sometimes citing each other 14, 15, 18, 19 or providing the same figures 14, 17, 19 or similar tables 14, 17, 19. The publication of seven reviews in 16 months, all independently reviewing the same evidence, led us to consider how many original publications about sublingual sufentanil existed altogether.…”

Special Considerations for the Treatment of Pain from Torture and War

“…Short-acting opioids delivered in novel ways with potential in the battlefield setting are fentanyl via a patient-controlled transdermal device [44] and sublingual administration of sufentanil [45]; both delivery systems avoid the need for intravenous access and reduce the risk of administration errors. Phase three clinical trials are currently underway for a new formulation of bupivacaine liposome [46], to establish whether this formulation lasts significantly longer than the standard drug.…”