Más sobre buprenorfina transdérmica

Sistema de buprenorfina transdérmica para terapia opioide en pacientes con dolor crónico lumbar bajo. Buprenorphine transdermal system for opioid therapy in patients with chronic low back pain. Gordon A, Rashiq S, Moulin DE, Clark AJ, Beaulieu AD, Eisenhoffer J, Piraino PS, Quigley P, Harsanyi Z, Darke AC. Mount Sinai Hospital, Toronto, Ontario, Canada. Pain Res Manag. 2010 May-Jun;15(3):169-78. Abstract OBJECTIVE: The present randomized, double-blinded, crossover study compared the efficacy and safety of a seven-day buprenorphine transdermal system (BTDS) and placebo in patients with low back pain of moderate or greater severity for at least six weeks. METHODS: Prestudy analgesics were discontinued the evening before random assignment to 5 microg/h BTDS or placebo, with acetaminophen 300 mg/codeine 30 mg, one to two tablets every 4 h to 6 h as needed, for rescue analgesia. The dose was titrated to effect weekly, if tolerated, to 10 microg/h and 20 microg/h BTDS. Each treatment phase was four weeks. RESULTS: Fifty-three patients (28 men, 25 women, mean [+/- SD] age 54.5+/-12.7 years) were evaluable for efficacy (completed two weeks or more in each phase). Baseline pain was 62.1+/-15.5 mm (100 mm visual analogue scale) and 2.5+/-0.6 (five-point ordinal scale). BTDS resulted in lower mean daily pain scores than in the placebo group (37.6+/-20.7 mm versus 43.6+/-21.2 mm on a visual analogue scale, P=0.0487; and 1.7+/-0.6 versus 2.0+/-0.7 on the ordinal scale, P=0.0358). Most patients titrated to the highest dose of BTDS (59% 20 microg/h, 31% 10 microg/h and 10% 5 microg/h). There were improvements from baseline in pain and disability (Pain Disability Index), Pain and Sleep (visual analogue scale), Quebec Back Pain Disability Scale and Short-Form 36 Health Survey scores for both BTDS and placebo groups, without significant differences between treatments. While there were more opioid-related side effects with BTDS treatment than with placebo, there were no serious adverse events. A total of 82% of patients chose to continue BTDS in a long-term open-label evaluation, in whom improvements in pain intensity, functionality and quality of life were sustained for up to six months without analgesic tolerance. CONCLUSION: BTDS (5 microg/h to 20 microg/h) represents a new treatment option for initial opioid therapy in patients with chronic low back pain. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2912613/pdf/prm15169.pdf  Manejo de buprenorfina transdérmica en pacientes que no han usado previamente opioides. Puig , R ; Rull , M ; Rev Soc Esp Dolor 13 (2006);2 :108 - 113 INTRODUCCIÓN La indicación de un analgésico se hace personalizada para un paciente determinado en base a la intensidad y tipo de dolor. Esto es válido tanto para el tratamiento del dolor agudo como crónico. Pero el paciente con dolor crónico tiene unas connotaciones diferenciales que condicionan la indicación analgésica. Seleccionaremos un fármaco con pocos efectos secundarios, la vía más cómoda, no dolorosa y que no limite la autonomía, en definitiva que proporcione una buena calidad de vida ahora y a largo plazo. Hasta el momento no disponemos de mejores fármacos analgésicos que los opioides para dolores de intensidad moderada a severa. No están exentos de efectos secundarios, pero se han encontrado nuevas formas de administración que mejoran los resultados. La forma de administración transdérmica ha supuesto un significativo avance para el tratamiento de los pacientes con dolor crónico. http://revista.sedolor.es/pdf/2006_02_06.pdf Parches analgésicos y desfibriladores: un cuento con moraleja. Analgesic patches and defibrillators: a cautionary tale. Brown MR, Denman R, Platts D. Advanced Heart Failure and Transplant Unit, The Prince Charles Hospital, Chermside, QLD 4032, Australia. martin_brown@health.qld.gov.au Europace. 2009 Nov;11(11):1552-3. Epub 2009 Oct 3. Abstract Implantable cardioverter defibrillator (ICD) insertions have increased significantly over the last decade. Transdermal patches are increasingly used for drug delivery. Skin burns associated with metal containing transdermal patches have been reported with magnetic resonance imaging and external cardiac defibrillation. However, there are no reports of dermal injury secondary to an ICD shock and a transdermal drug delivery patch. We report the first known case of a patient who suffered a dermal burn following a defibrillation due to a transdermal patch being positioned over the ICD. http://europace.oxfordjournals.org/content/11/11/1552.full.pdf+html

Atentamente Anestesiología y Medicina del Dolor www.anestesia-dolor.org