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Neue Applikationswege für Opioide

New modes of opioid administration

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Zusammenfassung

Seit einigen Jahren besteht zunehmendes Interesse an neuen Applikationswegen und-formen für Opioide. Untersucht werden insbesondere die buccale, die transdermale, die peripher-lokale und die nasale Opioidapplikation. Diebuccale Opioidgabe wurde vor allem im Rahmen von Prämedikationsstudien untersucht. Inzwischen liegen auch erste Studien zur buccalen Opioidgabe bei chronischen Tumorschmerzen und bei postoperativen Schmerzen vor. Diese Applikationsform scheint vor allem zur Therapie akuter Schmerzspitzen bei chronischen Karzinomschmerzen geeignet. Die Patientenakzeptanz gegenüber der buccalen Gabe ist hoch. Dietransdermale Fentanylgabe (TTS-Fentanyl) ist inzwischen gut untersucht. Vorteile dieser nichtinvasiven Applikationsform sind die ca. 72 Stunden dauernde Wirkung und eine hohe Patientenakzeptanz. TTS-Fentanyl scheint weniger zur Therapie akuter postoperativer Schmerzen, dagegen aber gut zur Behandlung langdauernder, chronischer Karzinomschmerzen geeignet. Zurperipher-lokalen Applikation von Opioiden liegen inzwischen etliche Publikationen vor. Aber nur in ca. der Hälfte dieser Studien konnte eine gute Schmerzlinderung nachgewiesen werden. Erfolgversprechend scheint vor allem die lokale Opioidapplikation im Bereich von entzündetem Gewebe zu sein. Dieintranasale Opioidgabe ist durch einen sehr schnellen Wirkungsbeginn ausgezeichnet. Die nasale Applikationsform scheint sich vor allem zur Therapie akuter Schmerzpspitzen im Rahmen chronischer Tumorschmerzen anzubieten. Es konnte eine hohe Patientenakzeptanz nachgewiesen werden.

Abstract

In the last few years great interest has developed in new modes of opioid administration; oral transmucosal, transdermal, peripheral, and nasal administration.Oral transmucosal administration of fentanyl citrate (OTFC) has most often been used for premedication in children. Meanwhile, studies on the use of OTFC in cancer patients for postoperative pain management have also been published. While OTFC may have a limited role in postoperative pain management, it may prove very helpful in the management of incident and breakthrough cancer pain. Patient acceptance is high, and the onset of action is relatively rapid.Transdermal administration of fentanyl (TTS fentanyl) has been extensively examined, especially in postoperative patients. Patient acceptance is high, and TTS-fentanyl-related side-effects (e.g. mild erythema at the site of application) are minor. Application is performed at 72-h intervals. Kinetics are stable with repeated dosing, and serum concentrations approach steady state with the first dose. The slow rise/decline in fentanyl plasma concentration with patch application/removal makes it less well suited for postoperative pain management. However, TTS fentanyl seems to be a promising mode of opioid administration for cancer patients.—Recent papers have unequivocally demonstrated a peripheral antinociceptive effect oflocally applied opioids, especially in inflamed tissue. However, the results of clinical investigations are equivocal so far: about half the reports demonstrate an analgesic effect of peripherally administered opioids, and the other half, not.Intranasal administration was introduced for premedication in children, but benzodiazepines seem to be the better and safer choice. Nonetheless, intranasal opioids guarantee a rapid rise in opioid plasma concentrations as well as a rapid onset of pain relief. This mode of administration seems to be especially suitable for the treatment of acute pain syndromes, such as breakthrough cancer pain or incident pain. Patient acceptance is high, and no local problems were reported.

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  1. Klinik für Anästhesiologie und operative Intensivmedizin Klinikum Steglitz Freie Universität Berlin, Hindenburgdamm 30, 12203, Berlin

    H. W. Striebel D.E.A.A., R. Schwagmeier & N. Boerger

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Striebel, H.W., Schwagmeier, R. & Boerger, N. Neue Applikationswege für Opioide. Schmerz 7, 131–139 (1993). https://doi.org/10.1007/BF02530420

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