Innovazioni nel trattamento del dolore acuto post-operatorio

Despite the availability of guidelines, treatment of acute pain after surgery is still a challenge. Although patient-controlled analgesia (PCA) systems represent the gold standard for the systemic administration of opioids, the majority of patients in Italy are treated with continuous intravenous (IV) infusion delivered through elastomeric pumps. Limitations of the currently available IV PCA could be one reason for the poor adherence to the guidelines observed in clinical practice. Recently, the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) have approved two new non-invasive pre-programmed PCA systems. The fentanyl iontophoretic transdermal system and the sufentanil sublingual nano tablet system have several potential advantages compared to the currently used PCA devices. In particular, they do not require an intravenous line and eliminate the risk of medication delivery errors typically associated with misprogramming IV PCA pumps. Further studies however are needed to address the potential interindividual variability especially in opioid tolerant patients.