Sufentanil preferred for Cancer pain


October 12, 2004 Volume 40 Issue 38

PALLIATIVE CARE UPDATE: The federal government chose the 15th International Congress on Care of the Terminally Ill to go public with its support for palliative care. Along with that initiative, the field will also be achieving a higher medical profile now that it is to be incorporated as a discipline in the curriculum of every medical school in Canada. Meanwhile, a new pilot program that applies the principles of nutritional rehabilitation to long-term cancer patients shows promise for potentially offering better quality of life. Staff writer Susannah Benady was at the conference and files reports here.


ICCTI: Sufentanil preferable to morphine for pain in terminal CA

By Susannah Benady

MONTREAL Sufentanil (Sufenta) given sublingually, instead of intravenously, provides rapid relief of movement-related or incident pain in people with advanced cancer, a University of Manitoba study of palliative care patients found.

The study showed that given sublingually, sufentanil was safe and markedly reduced the pain but without the side-effects of morphine. Incident pain is an acute exacerbation of pain that a patient with terminal illness experiences when having to perform activities, such as going to the bathroom.

"Patients rated their pain as 9.3 out of 10 before medication but only 2.7 post-medication," co-researcher Dr. Paul Daeninck, assistant professor of internal medicine at the University of Manitoba and an oncologist at Winnipeg's St. Boniface hospital, told the International Congress on Care of the Terminally Ill here (see pages 19 and 21).

"Patients found they were comfortable within 10 minutes, a much more reasonable wait than the half-hour it takes with morphine."

The researchers concluded that sufentanil is a better medication than morphine because of its rapid onset, high potency and rapid elimination from the body.

"Morphine lasts in the body for as long as four hours, so the associated drowsiness also lasts four hours, whereas with this drug, the whole process is over and done with within 40 minutes," said Dr. Daeninck.

The drug is available in Canada, but physicians are not familiar with it, he added. "It has typically been used by anesthesiologists, but in the past couple of years has grown in popularity for incident and postoperative pain."

The drug is more expensive than both morphine and fentanyl, but Dr. Daeninck stressed that because it is much more concentrated, patients need a much smaller amount of drug, a major advantage when administering sublingually.

"Sufentanil comes as a 50 mcg/mL solution, which is a potent enough dose. Fentanyl, on the other hand, also comes as 50 mcg/mL, but is 10 times weaker than sufentanil and the dosage required is too much for patients to keep under their tongue."




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