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Fink PB, Wheeler AR, Smith WR, Brant-Zawadzki G, Lieberman JR, McIntosh SE, Van Tilburg C, Wedmore IS, Windsor JS, Hofmeyr R, Weber D. Wilderness Medical Society Clinical Practice Guidelines for the Treatment of Acute Pain in Austere Environments: 2024 Update. Wilderness Environ Med 2024; 35:198-218. [PMID: 38651342 DOI: 10.1177/10806032241248422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
The Wilderness Medical Society (WMS) convened an expert panel to develop evidence-based guidelines for the management of pain in austere environments. Recommendations are graded based on the quality of supporting evidence as defined by criteria put forth by the American College of Chest Physicians. This is an update of the 2014 version of the "WMS Practice Guidelines for the Treatment of Acute Pain in Remote Environments" published in Wilderness & Environmental Medicine 2014; 25:41-49.
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Affiliation(s)
- Patrick B Fink
- Department of Emergency Medicine, University of Utah, Salt Lake City, UT
| | - Albert R Wheeler
- Department of Emergency Medicine, St. John's Health, Jackson, WY
| | - William R Smith
- Department of Emergency Medicine, St. John's Health, Jackson, WY
| | | | | | - Scott E McIntosh
- Department of Emergency Medicine, University of Utah, Salt Lake City, UT
| | | | - Ian S Wedmore
- Uniformed Services University of the Health Sciences, Bethesda, MD
| | | | - Ross Hofmeyr
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - David Weber
- Mountain Rescue Collective, LLC, Park City, UT
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Tan H, Wang C, Jiang Y, Shi Q, Liang W, Li D. Postoperative effect of sufentanil preemptive analgesia combined with psychological intervention on breast cancer patients. BMC Anesthesiol 2023; 23:170. [PMID: 37210488 DOI: 10.1186/s12871-023-02143-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 05/16/2023] [Indexed: 05/22/2023] Open
Abstract
OBJECTIVES To explore the postoperative effects of sufentanil preemptive analgesia combined with psychological intervention on breast cancer patients undergoing radical surgery. METHODS 112 female breast cancer patients aged 18-80 years old who underwent radical surgery by the same surgeon were randomly divided into 4 groups, and there were 28 patients in each group. Patients in group A were given 10 µg sufentanil preemptive analgesia combined with perioperative psychological support therapy (PPST), group B had only 10 µg sufentanil preemptive analgesia, group C had only PPST, and group D were under general anesthesia with conventional intubation. Visual analogue scoring (VAS) was used for analgesic evaluation at 2, 12 and 24 h after surgery and compared among the four groups by ANOVA method. RESULTS The awakening time of patients in group A or B was significantly shorter than that in group C or D, and the awakening time in group C was significantly shorter than that in group D. Moreover, patients in group A had the shortest extubation time, while the group D had the longest extubation time. The VAS scores at different time points showed significant difference, and the VAS scores at 12 and 24 h were significantly lower than those at 2 h (P < 0.05). The VAS scores and the changing trend of VAS scores were varied among the four groups (P < 0.05). In addition, we also found that patients in group A had the longest time to use the first pain medication after surgery, while patients in group D had the shortest time. But the adverse reactions among the four groups showed no difference. CONCLUSIONS Sufentanil preemptive analgesia combined with psychological intervention can effectively relieve the postoperative pain of breast cancer patients.
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Affiliation(s)
- Hong Tan
- Department of Anesthesiology, the Affiliated Hospital of Guilin Medical University, Guilin, 541001, Guangxi, China
| | - Chengqiang Wang
- Department of Epidemiology and Statistics, School of Public Health, Guilin Medical University, Guilin, 541199, Guangxi, China
| | - Yihong Jiang
- Department of Anesthesiology, the Affiliated Hospital of Guilin Medical University, Guilin, 541001, Guangxi, China
| | - Quan Shi
- Department of Anesthesiology, the Affiliated Hospital of Guilin Medical University, Guilin, 541001, Guangxi, China
| | - Wei Liang
- Department of Anesthesiology, the Affiliated Hospital of Guilin Medical University, Guilin, 541001, Guangxi, China
| | - Di Li
- Department of Epidemiology and Statistics, School of Public Health, Guilin Medical University, Guilin, 541199, Guangxi, China.
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Hutchings C, Yadav K, Cheung WJ, Young T, Sikora L, Eagles D. A systematic review of sufentanil for the management of adults with acute pain in the emergency department and pre-hospital setting. Am J Emerg Med 2023; 70:10-18. [PMID: 37186978 DOI: 10.1016/j.ajem.2023.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Pain is commonly encountered in the Emergency Department (ED) and pre-hospital setting and often requires opioid analgesia. We sought to synthesize the available evidence on the effectiveness of sufentanil for acute pain relief for adult patients in the pre-hospital or ED setting. METHODS This systematic review was conducted in accordance with PRISMA guidelines. Medline, Embase, Cochrane CENTRAL, and CINAHL were searched from inception to February 1, 2022. The grey literature was also searched. We included randomized controlled trials of adult patients with acute pain who were treated with sufentanil. Two reviewers independently completed screening, full text review, and data extraction. Primary outcome was reduction in pain. Secondary outcomes included adverse events, need for rescue analgesia, and patient and provider satisfaction. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. A meta-analysis was not performed due to heterogeneity. RESULTS Of 1120 unique citations, four studies (3 ED and 1 pre-hospital) met full inclusion criteria (n = 467 participants). The overall quality of the included studies was high. Intranasal (IN) sufentanil was superior to placebo for pain relief at 30 min (difference 20.8%, 95% CI 4.0-36.2%, p = 0.01). Both IN (two studies) and IV sufentanil (one study) were comparable to IV morphine. Mild adverse events were common and there was a higher propensity for minor sedation in patients receiving sufentanil. There were no serious adverse events requiring advanced interventions. CONCLUSION Sufentanil was comparable to IV morphine and was superior to placebo for rapid relief of acute pain in the ED setting. The safety profile of sufentanil is similar to IV morphine in this setting, with minimal concern for serious adverse events. The intranasal formulation may provide an alternative, rapid, non-parenteral route that could benefit our unique emergency department and pre-hospital patient population. Due to the overall small sample size of this review, larger studies are required to confirm safety.
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Affiliation(s)
- Caitlin Hutchings
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario K1Y 4E9, Canada.
| | - Krishan Yadav
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario K1Y 4E9, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario K1Y 4E9, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario K1Y 4E9, Canada
| | - Warren J Cheung
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario K1Y 4E9, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario K1Y 4E9, Canada
| | - Tayler Young
- Department of Family Medicine, Queens University, Kingston, Ontario K7L 3G2, Canada
| | | | - Debra Eagles
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario K1Y 4E9, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario K1Y 4E9, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario K1Y 4E9, Canada
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Sikand A, Parra JA, Weeks BH. Evaluation of sufentanil sublingual tablet 30 mcg for perioperative pain management of in-office rhinology procedures. OTOLARYNGOLOGY CASE REPORTS 2023. [DOI: 10.1016/j.xocr.2023.100521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
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Sublingual Sufentanil vs. Intravenous Fentanyl for the Treatment of Acute Postoperative Pain in the Ambulatory Surgery Center: A Randomized Clinical Trial. Anesthesiol Res Pract 2022; 2022:5237877. [PMID: 35844809 PMCID: PMC9286986 DOI: 10.1155/2022/5237877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/17/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives Sublingual sufentanil is a novel opioid medication to treat moderate to severe pain postoperatively. This study's aim was to determine if a single dose of a sublingual sufentanil tablet (SST) is as efficacious as a single dose of intravenous (IV) fentanyl in readiness to discharge from ambulatory surgery. Methods This was a two-arm, parallel group, randomized prospective outcomes study conducted at a single, free-standing ambulatory surgery center. Patients aged 18–80 undergoing general anesthesia who developed a postoperative pain score of ≥ 4 were enrolled and randomized to receive either 30 mcg SST or 50 mcg IV fentanyl. After their initial randomized dose, rescue IV fentanyl followed by oral oxycodone if needed. Recovery length of stay from arrival in the postanesthesia care unit until readiness to discharge criteria was met based on phase 2 discharge criteria. Results 75 patients were analyzed. Readiness to discharge from the recovery room was not significantly different between either group (IV fentanyl median 65 minutes; IQR 56–89; SST 73 min, IQR 58–89; p=0.903). There was no significant difference in the amount of morphine equivalents (MME) of rescue opioids needed (IV fentanyl median rescue MME of 22.5, IQR 13.1–23.4; SST median rescue MME of 15.0, IQR 7.5–30.0; p=0.742). The change in pain from PACU initially, and on discharge was not significantly different (IV fentanyl initial pain minus pain on discharge median 3, IQR 2–4; SST initial pain minus pain on discharge median 4, IQR 2–5.5; p=0.079). There was no difference in the six-item screener and the Overall Benefit of Analgesic Survey Score. Discussion. In conclusion, patients who received a sublingual sufentanil 30 mcg tablet had no significant differences in PACU length of stay or rescue analgesic usage when compared to intravenous fentanyl 50 mcg.
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Seify H. Awake Plastic Surgery Procedures: The Use of a Sufentanil Sublingual Tablet to Improve Patient Experience. AESTHETIC SURGERY JOURNAL OPEN FORUM 2022; 4:ojab056. [PMID: 35350112 PMCID: PMC8942103 DOI: 10.1093/asjof/ojab056] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Awake plastic surgery performed under minimal sedation has advantages
including patient preference, affordability, and easier recovery compared to
when performed under deeper sedation. Commonly used oral analgesics may not
be adequate for awake procedures resulting in moderate to severe pain.
Sufentanil sublingual tablet (SST) 30 mcg has been shown to provide timely
analgesia with a safety profile appropriate for minimal-sedation
settings. Objectives To examine perioperative outcomes in patients who underwent awake plastic
surgery with local anesthesia and SST 30 mcg for pain control. Methods This study was a prospective single-group cohort study conducted at a single
plastic surgery center. SST 30 mcg was administered approximately 30 minutes
prior to the procedure. Outcome measures included the number of patients
with adverse events, the number of patients requiring medications in the
post-anesthesia care unit (PACU), and recovery time. Results Among the 31 patients, the most common procedures were liposuction (71%),
facelift (10%), and blepharoplasty (6%). The mean (± standard error
[SE]) procedural duration was 81 ± 9 minutes. No vital sign instability
or oxygen desaturation was observed. Three patients (10%) experienced
nausea, only one of which required treatment with oral ondansetron 4 mg in
the PACU. One patient (3%) experienced dizziness that did not require
treatment. No patients required opioids or other analgesics in the PACU for
pain. The mean (±SE) recovery time was 15 ± 4 minutes. Conclusions Awake plastic surgery can be performed using SST 30 mcg with minimal side
effects and a rapid recovery time. Level of Evidence: 4
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Koushik SS, Schwartz RH, Cherkalin D, Sankar V, Shaparin N, Viswanath O. A Review of Sublingual Sufentanil Tablet (SST) and its Utility as an Analgesic Agent for Pain Procedures. Curr Pain Headache Rep 2022; 26:145-149. [PMID: 35076875 PMCID: PMC8787743 DOI: 10.1007/s11916-022-01014-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 11/30/2022]
Abstract
Purpose of Review Recent Findings Summary
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Affiliation(s)
- Sarang S Koushik
- Department of Anesthesiology & Pain Medicine, Keck School of Medicine of USC, 1520 San Pablo Street #3450, Los Angeles, CA, 90033, USA.
| | - Ruben H Schwartz
- Department of Anesthesiology & Pain Medicine, Keck School of Medicine of USC, 1520 San Pablo Street #3450, Los Angeles, CA, 90033, USA
| | - Denis Cherkalin
- Department of Anesthesiology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Vignesh Sankar
- Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, FL, USA
| | - Naum Shaparin
- Department of Anesthesiology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Omar Viswanath
- Department of Anesthesiology, University of Arizona College of Medicine, Phoenix, AZ, USA
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
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Leiman D, Jové M, Spahn GR, Palmer P. Patient and Healthcare Professional Satisfaction Ratings and Safety Profile of Sufentanil Sublingual Tablets for Treatment of Acute Pain: A Pooled Demographic Analysis. J Pain Res 2021; 14:805-813. [PMID: 33790642 PMCID: PMC8006952 DOI: 10.2147/jpr.s291359] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/02/2021] [Indexed: 11/30/2022] Open
Abstract
Objective This analysis reports the healthcare professional global assessment (HPGA) and patient global assessment (PGA) scores and the adverse event (AE) profile by age, body mass index (BMI), sex, and race from the three Phase III registration studies for sufentanil sublingual tablet (SST) 30 mcg. Methods Global assessments and treatment-related AEs were analyzed from patients treated with SST 30 mcg for moderate-to-severe acute pain following surgery or in the emergency department (ED). Pooled data were analyzed across patient demographic subgroups. Results A total of 283 patients were included in the HPGA/PGA analyses. The majority underwent abdominal surgery, with the remaining patients undergoing orthopedic or “other” types of surgery. Overall, SST 30 mcg was highly rated by both healthcare professionals and patients across the demographic subgroups. A total of 323 patients were included in the safety evaluation. The majority of patients did not experience any SST-related AEs; however, those that did experienced common opioid-related side effects such as nausea, headache, dizziness, and vomiting. No patients experienced unexpected AEs or required the use of naloxone. Conclusion SST 30 mcg was highly rated and well tolerated across demographic subgroups with the majority of patients not experiencing any adverse event related to SST 30 mcg. These findings support the use of sublingual sufentanil in all adult patients, regardless of age, BMI, sex, or race for the treatment of moderate-to-severe acute pain.
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Affiliation(s)
- David Leiman
- HD Research, Houston, TX, USA.,University of Texas at Houston, Department of Surgery, Houston, TX, USA
| | - Maurice Jové
- Atlanta Bone and Joint Specialists, Atlanta, GA, USA
| | - Gail Rosen Spahn
- Medical Affairs, AcelRx Pharmaceuticals, Inc, Redwood City, CA, USA
| | - Pamela Palmer
- Medical Affairs, AcelRx Pharmaceuticals, Inc, Redwood City, CA, USA
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