Patient considerations in the use of transdermal iontophoretic fentanyl for acute postoperative pain

Hartrick, Craig T.; Pestano, Cecile; Ding, Li; Danesi, Hassan

doi:10.2147/jpr.s89278

Cited by 7 publications

(4 citation statements)

References 25 publications

(40 reference statements)

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“… 48 An iontophoretic transdermal system (ITS), when used for administering fentanyl for postoperative pain management, was associated with a better ease-of-care profile and greater ease of mobility. 49 …”

Section: Pharmacological Managementmentioning

confidence: 99%

Postoperative pain management in the postanesthesia care unit: an update

Luo

Min

2017

JPR

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Acute postoperative pain remains a major problem, resulting in multiple undesirable outcomes if inadequately controlled. Most surgical patients spend their immediate postoperative period in the postanesthesia care unit (PACU), where pain management, being unsatisfactory and requiring improvements, affects further recovery. Recent studies on postoperative pain management in the PACU were reviewed for the advances in assessments and treatments. More objective assessments of pain being independent of patients’ participation may be potentially appropriate in the PACU, including photoplethysmography-derived parameters, analgesia nociception index, skin conductance, and pupillometry, although further studies are needed to confirm their utilities. Multimodal analgesia with different analgesics and techniques has been widely used. With theoretical basis of preventing central sensitization, preventive analgesia is increasingly common. New opioids are being developed with minimization of adverse effects of traditional opioids. More intravenous nonopioid analgesics and adjuncts (such as dexmedetomidine and dexamethasone) are introduced for their opioid-sparing effects. Current evidence suggests that regional analgesic techniques are effective in the reduction of pain and stay in the PACU. Being available alternatives to epidural analgesia, perineural techniques and infiltrative techniques including wound infiltration, transversus abdominis plane block, local infiltration analgesia, and intraperitoneal administration have played a more important role for their effectiveness and safety.

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Section: Pharmacological Managementmentioning

confidence: 99%

Postoperative pain management in the postanesthesia care unit: an update

Luo

Min

2017

JPR

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“…The fentanyl system has been found to improve mobility as assessed not only by the patients but also by the nurses and physical therapist. The facilitation of physical therapists' functioning may translate into an improved rehabilitation experience (38) . Diane et al conducted an analysis of the four studies to see summative usability evaluations, including behavior and subjective evaluation for the fentanyl Iontophoretic transdermal system (ITS).…”

Section: Discussionmentioning

confidence: 99%

Fentanyl Iontophoresis Can Facilitate Early Physiotherapy in Post Surgical Acute Pain: A Literature Review

Meena¹,

Kumar²,

Reinai

2021

Int J Health Sci Res

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Background: Iontophoresis is a technique of transferring ions into the tissues through the skin by using direct current. It can serve as a substitute for chemical enhancer, eliminates toxicity and adverse reaction formulation problems associated with chemical enhancer. Purpose: The purpose of this literature is to review the studies to see the effectiveness of Fentanyl Iontophoresis in the post operative acute pain and also to find out whether it helps in facilitating the physiotherapy in the post operative acute phase. Methods and Materials: The database literature search was carried out in the electronic database - Medline, and Research gate. Iontophoresis, Post-operative acute pain, Fentanyl Iontophoresis were the key words used to search in the electronic database. Randomized control trials, systematic review, meta-analysis, and case studies included into the review. Conclusion: Fentanyl iontophoresis system offers safety advantages in terms of opioid related drug adverse events (ORADEs) compared with morphine (iv) patient controlled analgesia for the management of acute postoperative pain. Fentanyl iontophoresis is highly potent and capable in relieving the post operative acute pain. This system of transferring ions into the tissues through the skin can play important role in initiating early physiotherapy and improve the mobility and functional limitations of the patient. Key words: Iontophoresis, Post-operative acute pain, Fentanyl Iontophoretic System.

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“…In a meta-analysis that was performed using the active-comparator trials, opioid-related adverse events (including respiratory depression and sedation) were assessed in the aggregate study population [ 24 ]. During the development program with more than 2500 patients treated with fentanyl ITS, there were no patients treated with fentanyl ITS who experienced clinically relevant respiratory depression (CRRD), and there were five patients in the morphine IV PCA group who did experience CRRD [ 25 ]. However, despite the low rates of CRRD in the clinical studies, it is still important to closely monitor patients being treated with any opioid, including fentanyl ITS, for signs of sedation and respiratory depression.…”

Section: Discussionmentioning

confidence: 99%

High Body Mass Index and Use of Fentanyl Iontophoretic Transdermal System in Postoperative Pain Management: Results of a Pooled Analysis of Six Phase 3/3B Trials

et al. 2016

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IntroductionPostoperative pain management can be challenging in patients with a high body mass index (BMI) especially as a result of poor venous access and delayed ambulation that can result in serious complications. Fentanyl iontophoretic transdermal system (ITS) is a needle-free, patient-controlled analgesic method available for use in acute postoperative pain. The primary objective of these analyses was to determine if there were any differences between patients with high BMI (>40 kg/m2) and lower BMIs (<30 kg/m2 and 35–40 kg/m2) in terms of efficacy or safety.MethodsData from three registration, placebo-controlled trials and three active-comparator trials using fentanyl ITS (IONSYS®, The Medicines Company, Parsippany, NJ) for the management of postoperative pain were analyzed using BMI categories of <35 kg/m2, 35–40 kg/m2, and >40 kg/m2. The majority of patients had lower abdominal or orthopedic surgery. For these analyses, the primary efficacy variables were assessed via patient global assessment of pain control (PGA) at 24 h and investigator global assessment (IGA) at study discharge. PGA and IGA are categorical 4-point scales (excellent, good, fair, or poor) with treatment “success” defined as either excellent or good. Safety was evaluated via treatment emergent adverse events (TEAEs).ResultsThere were 1403 patients randomly assigned and treated with fentanyl ITS for at least 3 h (BMI <35 kg/m2: 1180; 35–40 kg/m2: 136, BMI >40 kg/m2: 85; and 2 missing). PGA treatment success, which evaluates the method of pain control, at 24 h was consistent in the high and low BMI groups in patients treated with fentanyl ITS (<35 kg/m2: 946/1180 [80.2%]; 35–40 kg/m2: 103/136 [75.7%]; and >40 kg/m2: 65/85 [76.5%]). The IGA results at study discharge were similar to the PGA. Safety appeared similar with fentanyl ITS across the BMI groups.ConclusionIn these analyses, fentanyl ITS was as efficacious, as assessed by the PGA ratings of treatment “success”, in patients with high BMI (>40 kg/m2) as it was for those with lower BMIs (<35 kg/m2 or 35–40 kg/m2) and was generally well tolerated across all BMI categories.

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Patient considerations in the use of transdermal iontophoretic fentanyl for acute postoperative pain

Cited by 7 publications

References 25 publications

Postoperative pain management in the postanesthesia care unit: an update

Postoperative pain management in the postanesthesia care unit: an update

Fentanyl Iontophoresis Can Facilitate Early Physiotherapy in Post Surgical Acute Pain: A Literature Review

High Body Mass Index and Use of Fentanyl Iontophoretic Transdermal System in Postoperative Pain Management: Results of a Pooled Analysis of Six Phase 3/3B Trials

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