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Understanding the full utility
and side effects of fentanyl and
other phenylpiperidine formulations is crucial to find the best and
effective medication for perioperative and chronic pain management.
Acute pain usually starts suddenly and
is of sharp quality. Chronic pain is ongoing and lasts longer than
6 months, often continue after an injury has healed. Phenylpiperidines
derivatives can be used in getting relief from acute and chronic Pain. It has significant function in many aspects of
medicine like anesthesia and pain medicine. These agents are chemical class of
drugs with a phenyl moiety directly attached to piperidine.
The aim of this review
is to focus on phenylpiperidine derivatives and their use in current anesthesia
and perioperative medicine practice. Second generation synthetic phenylpiperidine which is a series of
opioid such as meperidine, fentanyl, was synthesized and introduced as fentanyl
citrate into clinical anesthesia practice in 1968. Fentanyl- mediated or
modulated responses enhance the pain threshold, and provides both analgesic and
sedative effects. It acts as an agonist at mu-opioid receptor, at the dorsal
horn inhibiting ascending pain pathways in the rostral ventral medulla. As
fentanyl is metabolized mainly via CYP3A4, its possibility that adverse effects
may occur with concomitant use of any drug which affects CYP3A4 activity.
Stopping the use of CYP3A4 inducers can also result in an increase in fentanyl
plasma concentration. The routes to administer Fentanyl-based formulations
could be intravenous, intramuscular, transdermal, transmucosal, and neuraxial
routes. Remifentanil which 2 times potent than Fenatanyl, can be used as ultra-short-acting
analgesic. The newer formulations of sufentanil, which is an analog and 5 to 10
times potent than Fentanyl, currently being evaluated for acute pain
management. We examine the routes of administration and clinical
considerations, including the role of opioids such as fentanyl as a natural
killer cell suppressive agent. Fentanyl and other opioids have been shown to
potentiate propagation of infection and cancer.
In recent years, fentanyl and
other phenylpiperidine formulations have been developed and successfully
marketed for chronic pain management. Due to complex physiological responses
and potential drug-drug interactions of opioids, the clinician should recognize
all the aspects of this drug class and consider all available options in
appropriate clinical settings.
Pain Physician
Current Concepts of Phenylpiperidine Derivatives Use in the Treatment of Acute and Chronic Pain
Nidal Elbaridi et al.
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