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Created: 8/10/2006
Updated: 26/9/2017

Transdermal fentanyl reference articles

i] Patient-controlled analgesia: Finding a balance between cost and comfort. Am J Health Syst Pharm. 2006 Apr 15;63(8 Suppl 1):S3-13; quiz S15-6. Viscusi ER, Schechter LN.  

Acute Pain Management Service, Department of Anesthesiology, Jefferson Medical College of Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.

PURPOSE: Despite the growing movement in acute pain management, acute postoperative pain continues to be undermanaged. Although numerous clinical practice guidelines for pain management have been published throughout the last 12 years, inadequate pain relief remains a significant health care issue. Insufficient dosage of analgesics is a common problem, and therapy for those patients still with pain represents a considerable health care dilemma. SUMMARY: Patient-controlled analgesia (PCA) refers to a process in which patients determine when and how much medication they receive, regardless of analgesic technique. Patient-controlled modalities using intravenous (i.v.) and epidural routes have dramatically improved postoperative pain management. PCA has emerged as an effective way for patients to manage their pain, allowing self-administration of small doses of analgesics to maintain a certain level of pain control. PCA is most commonly delivered via an intravenous or epidural route, and while patient satisfaction is higher with PCA than with conventional methods of analgesic administration, the invasiveness, costs, health care resources, and risk of errors associated with currently available modalities may limit their utility. The overall effectiveness of any analgesic technique depends on both the degree of pain relief and the incidence of side effects or complications. These adverse events of acute pain complicate postoperative recovery and may lead to longer hospital stays, as well as increased health care costs. Several new PCA modalities are being developed to address these limitations. These systems deliver drugs through a variety of routes (for example, transdermal). Most notable is a self-contained, credit card-sized fentanyl transdermal patient-activated system. It provides pain relief therapeutically equivalent to that of standard regimen of morphine i.v. PCA, with pharmacokinetics similar to those of intravenous fentanyl infusion. Fentanyl HCl patient-activated transdermal systems (PATS) may be an effective, noninvasive alternative to currently available i.v. PCA modalities. Whichever drug or device is utilized, the overall success relies on the expert supervision of nurses, pharmacists, and anesthesiologists in an acute pain service. CONCLUSION: Current PCA techniques using i.v. or epidural administration have limitations. Development of new technology offering alternative routes for PCA administration is at the forefronts of PCA research.

ii] Postoperative pain management with a patient-controlled transdermal delivery system for fentanyl. Am J Health Syst Pharm. 2005 Jun 1;62(11):1171-6. Koo PJ.

Pain Management, Department of Clinical Pharmacy and Pharmaceutical Services, School of Pharmacy, University of California, San Francisco, C-152, Box 062, 521 Parnassus Avenue, San Francisco, CA 94143-0622, USA.

PURPOSE: The efficacy and safety of fentanyl hydrochloride patient-controlled trans-dermal system (PCTS) for management of acute postoperative pain are discussed. SUMMARY: Fentanyl hydrochloride PCTS is a self-contained, needle-free, credit-card-sized fentanyl-delivery system that is worn on the patient's arm or chest. The system uses iontophoretic technology to actively deliver preprogrammed doses of fentanyl into the systemic circulation when activated by the patient on demand. PCTS is as safe and effective as i.v. morphine patient-controlled analgesia and superior to placebo for managing acute postoperative pain. Fentanyl absorption from PCTS is clinically insignificant when the device is not activated. This contrasts with the transdermal fentanyl patch, which delivers fentanyl continuously for 72 hours via passive absorption and is indicated only for use in the management of chronic pain. CONCLUSION: Fentanyl hydrochloride PCTS is a self-contained iontophoretic fentanyl-delivery system that provides patients control over pain management and consistent management of pain without analgesic peaks and troughs.

iii] The safety and efficacy of a fentanyl patient-controlled transdermal system for acute postoperative analgesia: a multicenter, placebo-controlled trial. Anesth Analg. 2004 Feb;98(2):427-33. Chelly JE, Grass J, Houseman TW, Minkowitz H, Pue A.

Department of Anesthesiology, University of Pittsburgh Medical Center, Pennsylvania 15261, USA.

A noninvasive method of delivery of parenteral opioids for management of acute pain may offer logistic advantages for patients and nursing staff. A patient-controlled transdermal system (PCTS) under development consists of a preprogrammed, self-contained drug-delivery system that uses electrotransport technology (E-TRANS, ALZA Corp, Mountain View, CA) to deliver 40 micro g of fentanyl HCl over 10 min per on-demand dose for patient-controlled analgesia (PCA). In this randomized, double-blinded, placebo-controlled trial we compared the efficacy and safety of on-demand fentanyl HCl PCTS 40 microg against placebo for postoperative pain up to 24 h after major abdominal, orthopedic, or thoracic surgery in 205 patients. The primary efficacy measurement was the percentage of patients withdrawn from the study because of inadequate analgesia after completing at least 3 h of treatment. Secondary efficacy measures included mean pain intensity (using visual analog scales), patient global assessments, and investigator global assessments. Of 189 patients considered evaluable for efficacy, 25% of patients in the fentanyl HCl PCTS 40 microg group withdrew because of inadequate analgesia, compared with 40.4% of the placebo group (P < 0.05). Use of fentanyl HCl PCTS 40 micro g was associated with lower VAS scores and higher mean patient and investigator global assessment scores compared with placebo. No patient experienced clinically relevant respiratory depression. This study showed that a fentanyl HCl PCTS 40 microg for PCA was superior to placebo and well tolerated for the control of moderate to severe postoperative pain for up to 24 h after major surgery. IMPLICATIONS: This multicenter, randomized, double-blinded, placebo-controlled trial showed that an on-demand fentanyl HCl patient-controlled transdermal system (PCTS) was superior to placebo and well tolerated for the control of moderate to severe postoperative pain for up to 24 h after major surgery. This fentanyl HCl PCTS is a preprogrammed, needle free, self-contained drug-delivery system that uses electrotransport technology (iontophoresis) to deliver 40 microg of fentanyl per on-demand dose.

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Other Pain references

i] Walder B et al. Efficacy and safety of patient-controlled opioid analgesia for acute postoperative pain. Acta Anaesthesiologica Scandinavica 2001 45: 795-804

ii] A qualitative and quantitative systematic review of preemptive analgesia for postoperative pain relief. The role of timing of analgesia. Møiniche S et al. Anesthesiology 2002 96: 725-741


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