Neuromodulation: Technology at the Neural Interface recently released its May/June 2012 issue that contains a fascinating study on sufentanil versus fentanyl. This article, authored by Eric. A. Seemann, PhD and K. Dean Willis, MD, et al. is part of a continuing study on the safety and efficacy of Intrathecal Drug Delivery Systems (IDDS) and related factors.

In this study, three hypotheses* were presented:

H1: Both fentanyl and sufentanil reduce chronic pain as measured by subjective pain ratings.

H2: Sufentanil, being approximately 7.5 times more potent than fentanyl (11), will control greater proportion of pain variance than Fentanyl.

H3: Patients maintained on sufentanil will be more satisfied with pain control over time than patients maintained on fentanyl.

*Hypotheses found in Neuromodulation 2012;15:194-199.

Seemann and Willis, et al.’s retrospective study analyzed 97 randomly selected IDDS patients over a period of two years – one year prior to IDDS implant and one year post-implant. All patients received an IDDS in or after 2000 due to concerns about granuloma formations, and no granuloma formations were identified in patients during the study. Of the population, 49 were maintained on sufentanil and 48 on fentanyl. All sufentanil patients were previously treated with fentanyl, and a majority were switched after reporting a lack of efficacy with fentanyl and complaining that IDDS therapy was ineffective. Catheter tip placement for all patients ranged from T12 to C3, but was most commonly in T8 or T9.

For this study, Seemann and Willis, et al. used subjective units of discomfort (SUDS) where the patient rated their pain on a scale of 1 to 10 (1=minor pain, 10=worst pain) at the beginning of each visit. Patients’ overall satisfaction with pain relief each visit was measured by a simple “yes” or “no” answer to whether or not they received analgesia.

The study indicated significant reduction in pain ratings over time for patients treated with both Fentanyl and Sufentanil; thus supporting H1. The results, however, demonstrated a nominal but noteworthy difference in analgesia between the two drugs. Both controlled a substantial proportion of pain, but sufentanil showed a marginally greater effect than Fentanyl; therefore, partially supporting H2.

Satisfaction with care for fentanyl patients did not change significantly over time; whereas, satisfaction with care for sufentanil patients did improve over time – thus supporting H3. One interesting result from this study is that sufentanil patients, unlike fentanyl patients, who are initially dissatisfied with treatment, may become satisfied over time. Also, sufentanil patients tend to be more satisfied with care at an earlier point in treatment than fentanyl patients.

The study concluded with a discussion stating that fentanyl and sufentanil are effective alternatives to morphine for use in implanted drug devices. Both drugs could reduce the number of office visits for refills because of their greater lipophilicity and aqueous solubility that allows for the administration of larger doses, and may reduce the risk of granuloma formation.

This is a fascinating study that I suggest everyone take a look at. What I have summarized here is just a small portion of the published work. To read the full article entitled, “Sufentanil Versus Fentanyl: Efficacy and Patient Satisfaction with Intrathecal Pain Management” get a copy of the May/June 2012 Issue of Neuromodulation: Technology at the Neural Interface by clicking here.

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Seeman E.A., Willis K.D., Mueller M.L., Stephenson D.D., Harden C.M., George J.M., Pinkerton L.A., White M.R., 2012 Sufentanil Vs. Fentanyl: Efficacy and Patient Satisfaction With Intrathecal Pain Management. Neuromodulation 2012; 15L 194-199.