"We're seeing novel drugs slowly try to make their way through
FDA approval — longer-acting local anesthetics, drugs that combine
anti-inflammatories with local anesthetics," says David Dickerson,
MD, section chief for pain medicine at NorthShore University
HealthSystem in Evanston, Ill., "but we've yet to see any of them
really come on the scene."
Until they do, here are several new and revived post-op pain man-
agement options to consider:
• Sublingual opioids. It might seem counterintuitive in the current
environment to tout a super-strong synthetic opioid, but sufentanil
could be a worthwhile pain management tool. Several times more
potent than its parent fentanyl, and hundreds of times more powerful
than morphine, sufentanil has been administered intravenously for
decades. But a sublingual form of the super-painkiller, approved by
the FDA in 2018, is gaining favor by giving providers an option for rap-
idly addressing severe post-op pain without going through the time,
expense and discomfort of placing an IV.
"It has some very beneficial qualities that can make it safer," says
Dr. Dickerson. "It has a fast onset and it's potent. But what's really
valuable is that, unlike opioids such as fentanyl, it provides a signifi-
cant potency with a very predictable on-off time in all patients."
The pain relief lasts the same duration, regardless of dosage or
patient size. "If you were to give a massive overdose of sufentanil, it's
going to last the same amount of time as if you gave a single dose,"
says Dr. Dickerson. "Not a lot of pain medicines have that forgiving
nature." This could be beneficial when you've taken the IV out of a
patient who is still complaining of severe pain.
With sublingual sufentanil on hand, you can treat immediate and
intense pain quickly, effectively and safely. "It's far cheaper to give a
single dose of sufentanil to get patients comfortable so they can go
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