PDF(Pubmed)
Abstract：
Opioid administration delivered intravenously (IV) by patient-controlled analgesia (PCA) devices has been an important development in addressing insufficient management of acute pain in the postsurgical setting. However, IV PCA has several disadvantages, including operator error, risk of patient exposure to analgesic gaps, IV line patency issues, and risk of catheter-related infection, all of which contribute to the total cost of care. Morphine, the most commonly used opioid in IV PCA, has a relatively slow onset of analgesia, which may leave patients with inadequate initial pain control and at risk of opioid dose-stacking. Sufentanil is an opioid with no major active metabolites and a rapid onset of analgesia. The sufentanil sublingual tablet system (SSTS) with a 20-minute lockout and other safety features is a novel noninvasive PCA system in development for on-demand relief of moderate to severe acute pain in the hospital setting. Data from phase 3 trials of the use of SSTS after elective major open abdominal and orthopedic surgery show that analgesia is rapidly achieved, with a longer mean interdosing interval compared with IV PCA morphine (81 vs 47 minutes) and a high level of patient and nurse satisfaction. These data suggest that SSTS may also aid in the avoidance of some of the pitfalls inherent with IV PCA, which may help reduce hospital costs associated with IV PCA-related issues. This article describes the evolution, benefits, issues, and costs associated with IV PCA and reviews data from preclinical studies of sufentanil through SSTS phase 3 trials.
摘要：
通过患者自控镇痛（PCA）装置静脉内（IV）递送的阿片类药物给药是解决手术后急性疼痛管理不足的重要发展。然而,IVPCA有几个缺点，包括操作员错误，患者暴露于镇痛间隙的风险，IV线通畅问题，和导管相关感染的风险，所有这些都会增加护理的总费用。吗啡,静脉PCA中最常用的阿片类药物，镇痛起效相对较慢，这可能会使患者的初始疼痛控制不足，并有阿片类药物剂量堆积的风险。舒芬太尼是一种无主要活性代谢产物且镇痛起效迅速的阿片类药物。具有20分钟锁定和其他安全功能的舒芬太尼舌下片系统（SSTS）是一种新型的无创PCA系统，正在开发中，可按需缓解医院环境中的中度至重度急性疼痛。选择性大开腹和骨科手术后使用SSTS的3期试验数据表明，镇痛迅速实现，与静脉注射PCA吗啡相比，平均给药间隔更长（81分钟vs47分钟），患者和护士满意度更高。这些数据表明，SSTS还可以帮助避免IVPCA固有的一些陷阱，这可能有助于降低与IVPCA相关问题相关的医院成本。这篇文章描述了进化，好处,问题,以及与静脉PCA相关的成本，并回顾了通过SSTS3期试验进行的舒芬太尼临床前研究的数据。
