SAN DIEGO – Pain management alternatives to opioids continue to evolve, according to Joseph F. Dasta, M.Sc. (Pharm.).
Dr. Joseph F. Dasta
New options include intravenous ibuprofen, approved in June 2009; nasal ketorolac, approved in May 2010; and intravenous acetaminophen, approved in November 2010.
Nonopioid alternatives are needed because data "suggest that opioids as well as untreated pain are associated with development of postoperative delirium," said Mr. Dasta, a health care consultant who is also a faculty member at the College of Pharmacy at the University of Texas, Austin.
Most of the available agents for pain management are short acting, "which can be good and bad," Mr. Dasta said at the annual congress of the Society of Critical Care Medicine. In addition, many of the currently approved agents for pain management require intravenous administration and may cause adverse drug reactions.
Intravenous diclofenac is currently being investigated as another possible therapy, Mr. Dasta said, as are the cyclo-oxygenase-2 selective inhibitors etoricoxib and parecoxib, and the nonsteroidal anti-inflammatory drug lornoxicam.
New studies of bupivacaine, an anesthetic drug that lasts for 6-10 hours, are also underway. "Several formulations are being developed whereby bupivacaine would be instilled into the surgical site, to the operative area, and last for several days," Mr. Dasta said. "Hopefully, we’ll see some of this technology come to market."
New guidelines from the Society of Critical Care Medicine on sedation analgesia and delirium are expected to be released later in 2011, Mr. Dasta said. Topics covered related to pain will include behavioral and physiologic measures of pain, procedural and nonprocedural pain, and the role of opioids, NMDA-receptor antagonists, and other nonopioids.
Mr. Dasta disclosed that he is a paid consultant for Cadence, Hospira, and Pacira Pharmaceuticals.