Sufentanil is the name given to the strongest painkiller approved for use in human medicine in Germany. It belongs to the group of synthetic opioids.
What is sufentanil?
Sufentanil is the strongest painkiller approved for use in human medicine. It is used primarily in anesthesia. Sufentanil is a potent analgesic that bears a structural similarity to fentanyl-containing analgesics. It is primarily used in the field of anesthesia and is the strongest approved analgesic in Germany. The development of sufentanil took place in the 1970s. The first publication of the analgesic was in 1976 by the Belgian chemist Paul Janssen (1926-2003). Janssen had previously synthesized fentanyl. Sufentanil came into use in the late 1980s and became a proven anesthetic for surgical procedures. Sufentanil is sold in Central Europe under the product name Sufenta. In addition, there are several generics on the market. In Germany, the use of sufentanil without a prescription or authorization is in principle punishable by law. Thus, the opioid can be misused as a psychotropic or depressant intoxicant. According to the Narcotics Act (BtMG), sufentanil is considered a prescription drug for anesthesia in this country.
Pharmacologic effect
Sufentanil is classified as a highly effective analgesic. Thus, its pain inhibition is significantly greater than that of morphine. The effect sets in within minutes after the opioid is administered. Since sufentanil accumulates in the human body only to a limited extent and is rapidly excreted, its potency can be easily assessed. It depends on the dose and is adapted to the intensity of the surgical procedure. Sufentanil achieves its effect via the opioid receptors. These are located particularly in the central nervous system (CNS). Sufentanil binds to both the µ-opioid receptor and the K-receptor. This produces the characteristic effects of opioids such as respiratory depression, analgesia, constriction of the pupils, and euphoria. Sufentanil has seven to ten times the analgesic potency of fentanyl. For morphine, it is 700 to 1000 times. This makes sufentanil the most potent opioid in medical use. Because of its good solubility in fats, the analgesic can spread rapidly in fatty tissues. The duration of action of sufentanil is approximately 30 to 45 minutes. Degradation of the drug occurs primarily in the liver. A smaller portion passes out of the organism via the kidneys without any changes. Compared to other opioids such as fentanyl, sufentanil has the advantage that severe side effects only occur at a high dose. The cardiovascular system, blood clotting and immune system are also subject to hardly any changes. In addition, the neurotransmitter histamine is also not released by sufentanil.
Medical application and use
The use of sufentanil is mainly in anesthesia as well as intensive care medicine, where it serves as an analgesic. In this context, the analgesic is used in adult patients as well as in children. The drug is used to combat pain, but is also used with other active ingredients as an anesthetic component. Sufentanil is usually administered intravenously through a syringe pump via a vein. Epidural anesthesia near the spinal cord is another administration option. However, it is important to always administer the opioid only under medical supervision because of its potent analgesic potency. In this way, possible respiratory depression cannot be overlooked. Intensive care medicine resorts to sufentanil for continuous analog sedation because it is easier to control than fentanyl. In addition, its sedative effects are more pronounced and respiratory depression is rarely seen. Preferred uses of sufentanil include surgical, gynecologic, and orthopedic procedures.
Risks and side effects
Just as with other opioids, the occurrence of adverse side effects is possible with sufentanil. These primarily include suppression of respiratory function, nausea, vomiting, constriction of the pupils, itching, and blunting.Other conceivable side effects include headache, discoloration of the skin, dizziness, drowsiness, high or low blood pressure, urinary incontinence, urinary retention, constipation, pallor, palpitations, fever, muscle stiffness or muscle twitching. Babies may experience a bluish discoloration of the skin and tremors. In the case of a rapid and single dose of sufentanil, it is not uncommon for patients to suffer from coughing difficulties. If epidural administration of sufentanil is performed, side effects such as urinary retention, nausea, and pruritus are more common. If the patient suffers from hypersensitivity to sufentanil or other opioids, the analgesic should not be administered. In addition, the drug should not be used during child birth because of the potential for suppression of the infant’s respiratory function. Weighing the risks and benefits of sufentanil administration must be done by a doctor in case of hypothyroidism, renal or hepatic dysfunction, craniocerebral injuries, increased intracranial pressure, lung diseases associated with respiratory impairment, obesity, alcohol addiction, babies with birth defects or elderly patients. During pregnancy, sufentanil should be administered only if the physician deems it absolutely necessary. This allows the opioid to penetrate the placenta, which in turn causes withdrawal symptoms in the baby. Because sufentanil also passes into breast milk, the painkiller must never be administered during breastfeeding. The mother cannot breastfeed her child until 24 hours after the end of the anesthetic. If sufentanil is taken at the same time as drugs that suppress brain function, there is a risk of interaction. For example, suppression of respiratory function is exacerbated by the administration of opioid analgesics, neuroleptics, anesthetics, the sleep aid etomidate, or alcohol.
