Iontophoretic transdermal system using fentanyl compared with patient-controlled intravenous analgesia using morphine for postoperative pain management

• Published in: British journal of anaesthesia : BJA Vol. 98; no. 6; pp. 806 - 815
• Main Authors: Grond, S., Hall, J., Spacek, A., Hoppenbrouwers, M., Richarz, U., Bonnet, F.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01-06-2007; Oxford University Press; Oxford Publishing Limited (England)
• Subjects: Administration, Cutaneous; Adult; Aged; Aged, 80 and over; analgesia; analgesia, patient-controlled; Analgesia, Patient-Controlled - adverse effects; Analgesia, Patient-Controlled - methods; analgesia, postoperative; analgesic techniques; analgesic techniques, transdermal iontophoresis; analgesics opioid; analgesics opioid, fentanyl; analgesics opioid, morphine; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - adverse effects; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Attitude of Health Personnel; Biological and medical sciences; Female; fentanyl; Fentanyl - administration & dosage; Fentanyl - adverse effects; Humans; Iontophoresis - adverse effects; Iontophoresis - methods; Male; Medical sciences; Middle Aged; morphine; Morphine - administration & dosage; Morphine - adverse effects; Pain Measurement - methods; Pain, Postoperative - drug therapy; Patient Satisfaction; patient-controlled; postoperative; Prospective Studies; transdermal iontophoresis; analgesics opioid, fentanyl; analgesics opioid, morphine; analgesic techniques, transdermal iontophoresis; analgesia, patient-controlled; analgesia, postoperative; Human; Postoperative; Agonist; Intravenous administration; μ Opioid receptor; Fentanyl; postoperative; analgesics opioid; Opiates; Morphine; patient-controlled; analgesia; Narcotic analgesic; Analgesia; Iontophoresis; Clinical management; Pain; fentanyl; analgesics opioid; transdermal iontophoresis; Anesthesia; morphine; analgesic techniques
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1093/bja/aem102

The fentanyl iontophoretic transdermal system (fentanyl ITS) enables needle-free, patient-controlled analgesia for postoperative pain management. This study compared the efficacy, safety, and ease of care of fentanyl ITS with patient-controlled, i.v. analgesia (PCIA) with morphine for postoperative pain management.
A prospective, randomized, multicentre trial enrolled patients in Europe after abdominal or orthopaedic surgery. Patients received fentanyl ITS (n = 325; 40.0 µg fentanyl over 10 min) or morphine PCIA [n = 335; bolus doses (standard at each hospital)] for ≤72 h. Supplemental i.v. morphine was available during the first 3 h. The primary efficacy measure was the patient global assessment (PGA) of the pain control method during the first 24 h.
PGA ratings of ‘good’ or ‘excellent’ were reported by 86.2 and 87.5% of patients using fentanyl ITS or morphine PCIA, respectively (95% CI, −6.5 to 3.9%). Mean (sd) last pain intensity scores (numerical rating scale, 0–10) were 1.8 (1.77) and 1.9 (1.86) in the fentanyl ITS and morphine PCIA groups, respectively (95% CI, −0.38 to 0.18). More patients reported a system-related problem for fentanyl ITS than morphine PCIA (51.1 vs 17.9%, respectively). However, fewer of these problems interrupted pain control (4.4 vs 41.3%, respectively). Patients, nurses, and physiotherapists reported more favourable overall ease-of-care ratings for fentanyl ITS than morphine PCIA. Study termination rates and opioid-related side-effects were similar between groups.
Fentanyl ITS and morphine PCIA were comparably effective and safe.