New methods, medication may increase options
Although there have been few changes in medications or techniques to control postoperative pain for same-day surgery patients in recent years, there are several promising advances in the works, say experts interviewed by Same-Day Surgery.
Studies of parecoxib sodium, an investigational parenteral cyclooxygenase-2 (COX-2) specific inhibitor, show positive pain control for post-surgical pain, says Jeffrey L. Apfelbaum, MD, director of outpatient surgery at the University of Chicago Hospitals. "The injectable COX-2 inhibitor can be given before, during, or after surgery and will suppress pain for six to 12 hours or more," he says. "This drug does not create side effects such as gastrointestinal upset or bleeding problems seen with Ketoraloc."
Pharmacia Corp. in Peapack, NJ, is the manufacturer of the injectable COX-2 inhibitor that has been submitted for approval by the Food and Drug Administration. The company expects to market the drug by the end of 2001, says Angela Jerzak, public relations representative with BSMG Medical & Health Communications in Chicago and spokeswoman for Pharmacia. The drug works by affecting the production of the COX-2 enzyme that is produced by the body at the site of an injury, she says. The enzyme mediates pain, fever, and inflammation, so the COX-2 inhibitor reduces pain by inhibiting the production of the enzyme, she explains. The injectable drug that is being studied works well when given intravenously during surgery, she adds.
In addition to new medications, new ways of delivering medication also are being investigated, says T.J. Gan, MD, director of clinical research at Duke University Medical Center in Durham, NC, and associate professor of anesthesiology. "A current study is looking at the use of a credit card-sized mechanism that delivers pain medication through the skin with a simple push of a button," says Gan. Similar to a personal, mobile PCA pump, the transdermal system (ALZA Corp., Mountain View, CA) delivers a set amount of medication, and the patient feels a tingling sensation, he adds. (For more information, see "Sources" at end of article.)
For the past few years, orthopedic surgeons also have been using pain medication pumps that go home with patients, says Jeffrey A. Katz, MD, assistant professor of anesthesiology at Northwestern University Medical Center in Chicago. "While there are a number of advantages to delivering the anesthetic directly to the surgical site postoperatively, the disadvantages may include dislodged tubing or additional risk of infection," he points out.
Sources
ALZA Corp. produces two transdermal pain control products, the D-TRANS system and the E-TRANS system. The E-TRANS system is in phase III clinical development. For more information about transdermal pain control, contact: ALZA Corp., 1900 Charleston Road, Mountain View, CA 94309-7210. Telephone: (650) 564-5000. Fax: (650) 564-5151. Web: www.alza.com.
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