[New modes of opioid administration.]

In the last few years great interest has developed in new modes of opioid administration; oral transmucosal, transdermal, peripheral, and nasal administration.Oral transmucosal administration of fentanyl citrate (OTFC) has most often been used for premedication in children. Meanwhile, studies on the use of OTFC in cancer patients for postoperative pain management have also been published. While OTFC may have a limited role in postoperative pain management, it may prove very helpful in the management of incident and breakthrough cancer pain. Patient acceptance is high, and the onset of action is relatively rapid.Transdermal administration of fentanyl (TTS fentanyl) has been extensively examined, especially in postoperative patients. Patient acceptance is high, and TTS-fentanyl-related side-effects (e.g. mild erythema at the site of application) are minor. Application is performed at 72-h intervals. Kinetics are stable with repeated dosing, and serum concentrations approach steady state with the first dose. The slow rise/decline in fentanyl plasma concentration with patch application/removal makes it less well suited for postoperative pain management. However, TTS fentanyl seems to be a promising mode of opioid administration for cancer patients.-Recent papers have unequivocally demonstrated a peripheral antinociceptive effect oflocally applied opioids, especially in inflamed tissue. However, the results of clinical investigations are equivocal so far: about half the reports demonstrate an analgesic effect of peripherally administered opioids, and the other half, not.Intranasal administration was introduced for premedication in children, but benzodiazepines seem to be the better and safer choice. Nonetheless, intranasal opioids guarantee a rapid rise in opioid plasma concentrations as well as a rapid onset of pain relief. This mode of administration seems to be especially suitable for the treatment of acute pain syndromes, such as breakthrough cancer pain or incident pain. Patient acceptance is high, and no local problems were reported.