Transdermal Fentanyl: A New Approach to Prolonged Pain Control

206 Pages·1991·4.58 MB·English

by  S. S. Hwang

K. A. Lehmann D. Zech (Eds.)
Transdermal
Fentanyl
A New Approach
to Prolonged Pain Control
With 57 Figures and 37 Tables
Springer-Verlag
Berlin Heidelberg New York
London Paris Tokyo
Hong Kong Barcelona
Budapest
Prof. Dr. Dr. Klaus A. Lehmann
Dr. Detlev Zech
Institut für Anaesthesiologie und
Operative Intensivmedizin
Universität Köln
Joseph-Stelzmann-Str. 9
D-5000 Köln 41
ISBN-13: 978-3-540-54440-1 e-ISBN-13: 978-3-642-76872-9
DOI: 10.1007/978-3-642-76872-9
Library of Congress Cataloging-in-Publication Data
Transdermal fentanyl / K. A. Lehmann, D. Zech (eds.).
p. cm.
Results of a workshop held in Cologne, Federal Republic of Germany, Sept. 27-28, 1990.
Includes index.
1. Fentanyl -Congrcsses. 2. Transdermal medication -Congrcsscs.
I. Lehmann, K. A. (Klaus A.) II. Zech, D.
[DNLM: 1. Administration, Cutaneous -congrcsses. 2. Fentanyl -administration & dosage -con
gresses. 3. Fentanyl -therapeutic use -congresses. 4. Pain -drug therapy -congresses. QV 89 TI72
1990]
RD86.F45T73 1991
615' .783--dc20
DNLMIDLC
for Library of Congress 91-5144
CIP
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Preface
Pain is a serious clinical problem requiring considerable effort by physicians
and the nursing staff. Although many methods of effective pain management
are available, in daily practice the clinical outcome leaves much to be
desired.
The medical community should not simply wait for "better" or more
"modern" techniques to be developed but should play an active role in solving
these problems. Gradually new, really promising strategies are being
introduced. Transdermal administration of a variety of drugs, including
cardiovascular drugs, antiemetics and hormones, has become a well
established modality. Experience with opiates administered transdermally
goes back several years; most recently the transdermal therapeutic system
(TTS) fentanyl was approved by the United States Food and Drug
Administration.
I am pleased to present the results of a comprehensive international
workshop entitled "Trans dermal Fentanyl," held in Cologne, Federal
Republic of Germany from September 27-28, 1990. Its purpose was to
facilitate critical evaluation of theoretical and clinical studies on the new,
noninvasive application of fentanyl, and to provide an opportunity for an
exchange of ideas concerning its value for pain management, anesthesiology,
and future investigations in this field.
The reader will find that the experts appreciated the value of transdermal
analgesia but also warned against uncritical optimism. Experience to date has
shown that TTS fentanyl can be a valuable tool in the clinician's arm amen
tarium against pain. It should, however, be kept in mind that it represents a
new application mode and not a new drug, and that sustained, noninvasive
application requires careful dia gnosis and good general standards of pain
management,.
The future will show which patients profit best from TTS fentanyl. May this
book help the physician to identify such patients and offer encouragement to
provide other effective methods of pain management to those who are
possibly better off with conventional techniques.
I gratefully acknowledge the help of all the speakers and discussants at the
workshop and the generous support of the meeting, provided by STADA AG
Arzneimittel, which greatly facilitated speedy publication of the proceed
ings.
Cologne, Spring 1991 Klaus A. LEHMANN
Contents
Part I Transdermal Therapeutic Systems - An Introduction
Transdermal Permeation: Physiological
and Physicochemical Aspects
S. S. Hwang, K. C. Nichols, and M. Southam 1
Transdermal Therapeutic Systems in Clinical Use:
Development and Applications
WS. Nimmo .................. . 8
Part 11 eurrent Aspects of Pain Management
Postoperative Pain
K. A. Lehmann, S. Grond, and D. Zech 17
Cancer Pain
R. Payne .. 36
Pain Management and Quality of Life in Cancer Patients
C. M. Moinpour and C. R. Chapman . . . . . . . 42
Opioid Analgesia for Chronic, Nonmalignant Pain
M. Strumpf and M. Zenz . . . . . . . . . . . . . 64
Part 111 Noninvasive Fentanyl Application
Pharmacokinetics of Fentanyl
L. E. Mather and G. K. Gourlay 73
Premedication and Pain Management
with Oral Transmucosal Fentanyl
J. B. Streisand . . . . . . . . . . . . 98
VIIT Contents
Transdermal Fentanyl:
an Overview of Pharmacokinetics, Efficacy and Safety
M. Southam, S. Gupta, M. Knowles, and S. S. Hwang 107
Part IV Postoperative Pain Management with TIS Fentanyl
Pharmacokinetics and Pharmacodynamics
G. K. Gourlay and L. E. Mather ..... 119
Clinical Experience
B. von Bormann . 141
Respiratory Safety
L. Latasch and R. Christ 149
TTS Fentanyl in Combination with Patient-Controlled
Analgesia
C. Einnolf, H. J. Eberlein, and K. A. Lehmann . . . 158
Part V Cancer Pain Management with TIS Fentanyl
Clinical Experience
D. Zech, S. Grond, and J. Lynch 171
Part VI Other Transdermal Therapentic Systems for Anesthesia
and Pain Management
Local Anesthetics: Eutectic Mixture of Local Anesthetics
M. Y. Dubois ....................... 191
Scopolamine
1. Tigerstedt 195
Subject index . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 201
Contributors
VON BORMANN, BENNO
Abteilung Anaesthesiologie und Operative Intensivmedizin,
St. lohannes-Hospital, An der Abtei 7-11, 4100 Duisburg 11,
Federal Republic of Germany
CHAPMAN,C. RJCHARD
Departments of Anesthesiology and Psychiatry and Behavioral Sciences,
University of Washington, Seattle, WA 98195, USA
CHRIST, RAINER
E. Merck, Frankfurter Str. 250, 6100 Darmstadt,
Federal Republic of Germany
DUBOIS, MICHEL Y
Department of Anesthesiology, Georgetown University, Medical Center,
3800 Reservoir Road NW, Washington DC 20007, USA
EBERLEIN, H. J.
Institut für Anaesthesiologie und Operative Intensivmedizin, FU Berlin,
Klinikum Charlottenburg, Spandauer Damm 130, 1000 Berlin 19,
Federal Republic of Germany
EINNOLF, CHRISTIANE
Institut für Anaesthesiologie und Operative Intensivmedizin, FU Berlin,
Klinikum Charlottenburg, Spandauer Damm 130, 1000 Berlin 19,
Federal Republic of Germany
GOURLAY, GEOFFREY K.
Pain Management Unit, Flinders Medical Centre, Bedford Park,
Adelaide SA 5042, Australia
GROND, STEFAN
Institut für Anaesthesiologie und Operative Intensivmedizin,
Universität Köln, loseph-Stelzmann-Straße 9, 5000 Köln 41,
Federal Republic of Germany
X Contributors
GUPTA, SUNEEL
Alza Corporation, 950 Page Mill Road, Palo Alto, CA 94303-0802, USA
HWANG, STEPHEN S.
Alza Corporation, 950 Page Mill Road, Palo Alto, CA 94303-0802, USA
KNOWLES, MARK
Alza Corporation, 950 Page Mill Road, Palo Alto, CA 94303-0802, USA
LATASCH, LEO
Abteilung für Anaesthesie und Wiederbelebung, Universitätsklinik
Frankfurt am Mahl, Theodor-Stern-Kai 7,6000 Frankfurt am Main,
Federal Republic of Germany
LEHMANN, KLAUS A.
Institut für Anaesthesiologie und Operative Intensivmedizin,
Universität Köln, loseph-Stelzmann-Straße 9, 5000 Köln 41,
Federal Republic of Germany
LYNCH,JOHN
Institut für Anaesthesiologie und Operative Intensivmedizin,
Universität Köln, loseph-Stelzmann-Straße 9, 5000 Köln 41,
Federal Republic of Germany
MATHER, LAURENCE E.
Department of Anaesthesia and Pain Management, The University of
Sydney, Royal North Shore Hospital, St. Leonards, NSW 2065, Australia
MOINPOUR, CAROL M.
Pain and Toxicity Research Program, Fred Hutchinson Cancer Research
Center, 1124 Columbia Street, Seattle, WA 98104, USA
NICHOLS, KIRSTIN C.
Alza Corporation, 950 Page Mill Road, Palo Alto, CA 94303-0802, USA
NIMMO, WALTER S.
Inveresk Clinical Research Ltd, Research Park Riccarton,
Edinburgh EIl 14 4Ap, United Kingdom
PAYNE, RICHARD
Department of Neurology, University of Cincinnati Medical Center,
231 Bethesda Avenue, Cincinnati, Ohio 45267, USA
SOUTHAM, MARY A.
Alza Corporation, 950 Page Mill Road, Palo Alto, CA 94303-0802, USA
Contributors XI
STREISAND, JA MES B.
Department of Anesthesiology, University of Utah School of Medicine,
50 North Medical Drive, Salt Lake City UT 84132, USA
STRUMPF, MICHAEL
Institut für Anaesthesiologie, Bergmannsheil, Universität Bochum,
Gilsingstraße 14, 4630 Bochum 1, Federal Republic of Germany
TIGERSTEDT, IRMA
Department of Anaesthesia, Helsinki University Central Hospital,
Haartmaninkatu 4, SF-00290 Helsinki, Finland
ZECH, DETLEV
Institut für Anaesthesiologie und Operative Intensivmedizin,
Universität Köln, loseph-Stelzmann-Straße 9, 5000 Köln 41,
Federal Republic of Germany
ZENZ, MICHAEL
Institut für Anaesthesiologie, Bergmannsheil, Universität Bochum,
Gilsingstraße 14, 4630 Bochum 1, Federal Republic of Germany
Part I. Transdermal Therapeutic Systems -
An Introduction