Meta-Analysis of the Ease of Care From the Nurses' Perspective Comparing Fentanyl Iontophoretic Transdermal System (ITS) Vs Morphine Intravenous Patient-Controlled Analgesia (IV PCA) in Postoperative Pain Management

Pestano, Cecile; Lindley, Pam; Ding, Li; Danesi, Hassan

doi:10.1016/j.jopan.2015.11.012

Cited by 5 publications

(4 citation statements)

References 24 publications

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“…19 Pooled analyses (N = 1882) were conducted to evaluate patient mobility from these three studies. 20 The difference of the overall and individual mobility scores in this pooled analysis favoured fentanyl ITS over morphine IV PCA (p < 0.001). Two of the four pivotal trials included physical therapy rating of mobility via the Physical Therapy EOC questionnaire with three questions regarding the patient transferring to a chair, ambulating around in a room and ambulating outside of the room.…”

Section: Introductionmentioning

confidence: 76%

Comparison of fentanyl iontophoretic transdermal system and routine care with morphine intravenous patient-controlled analgesia in the management of early postoperative mobilisation: results from a randomised study

Langford

Chang

Ding

et al. 2016

British Journal of Pain

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Introduction: Fentanyl iontophoretic transdermal system (ITS) (IONSYS ® , The Medicines Company, Parsippany, NJ, USA) and morphine intravenous (IV) patient-controlled analgesia (PCA) have demonstrated equivalent pain control in several published studies. The primary objective of the current study was to compare fentanyl ITS with morphine IV PCA with regard to the patient's ability to mobilise with acute postoperative pain. Methods: In this multicentre, open-label, randomised, active-controlled, prospective phase IV study, postoperative patients initially received IV morphine and were titrated to pain score ⩽4out of 10 on a Numeric Rating Scale (NRS) and then received fentanyl ITS (up to 240 µg (6 doses)/hour; up to a maximum of 3.2 mg (80 doses)/24 hours) or morphine IV PCA (doses up to 20 mg morphine/2 hours, up to 240 mg/24 hours). The primary efficacy measure was ability to mobilise, assessed using patient responses to three validated questions regarding mobility on a 6-point Likert scale (0 = no difficulty to mobilise to 5 = a very great deal of difficulty to mobilise). The study was originally planned to include ~200 patients. However, following the early suspension and termination of the study, a total of 108 patients were randomised to study treatment. Results: One hundred and eight patients were recruited prior to undergoing surgical procedures (orthopaedic surgical procedures (72%) or underwent major abdominal procedures (28%)). Postoperatively, 58 were randomised to receive fentanyl ITS, and 50 to morphine IV PCA. Fentanyl ITS patients had a greater ability to mobilise at the time of stopping study drug, with an adjusted mean ability to mobilise score (95% confidence interval (CI)) of 0.14 (−0.19, 0.47) for fentanyl ITS patients and 2.37 (1.98, 2.76) for morphine IV PCA patients (p < 0.001). Conclusion: Patients treated with fentanyl ITS reported that they were better able to mobilise than patients treated with morphine IV PCA, at all time-points following surgery out to 24 hours.

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Section: Introductionmentioning

confidence: 76%

Comparison of fentanyl iontophoretic transdermal system and routine care with morphine intravenous patient-controlled analgesia in the management of early postoperative mobilisation: results from a randomised study

Langford

Chang

Ding

et al. 2016

British Journal of Pain

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“…Fentanyl and morphine are powerful opioids; therefore, it is expected that the pain control is similar between these two modalities (fentanyl ITS and morphine IV PCA). However, the additional benefits of fentanyl ITS relating to the validated instruments of physical therapy ease-of-care [ 14 ], nurse ease-of-care [ 15 ], and patient ease-of-care [ 16 ] have been evaluated and published in other analyses of the full phase 3 dataset. In addition, postoperative mobility is important for every patient undergoing surgery and especially so for obese patients.…”

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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“…TD fentanyl patches are currently specifically contraindicated for the management of acute or postoperative pain in many countries [ 59 ]. Instead, the fentanyl iontophoretic transdermal system has a greater acceptance by nurses and patients than morphine IV PCA [ 60 ].…”

Section: Routes Of Administrationmentioning

confidence: 99%

The Routes of Administration for Acute Postoperative Pain Medication

Puntillo

Giglio²,

Varrassi

2021

Pain Ther

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Effective treatment of postoperative acute pain, together with early mobilization and nutrition, is one of the perioperative strategies advocated to improve surgical outcome and reduce the costs of hospitalization. Moreover, adequate pain control reduces perioperative morbidity related to surgical stress and can also prevent the incidence of chronic postoperative pain syndromes, whose treatment is still a challenge. The choice of the most appropriate analgesics depends not only on the drug class, but also on the most suitable route of administration, the best dosage for that route, and unique limitations and contraindications for every patient. In the present review, a comprehensive analysis was performed on the different routes of administration of acute postoperative pain medications and their indications and limitations, focusing on recent evidence and international recommendations.

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Meta-Analysis of the Ease of Care From the Nurses' Perspective Comparing Fentanyl Iontophoretic Transdermal System (ITS) Vs Morphine Intravenous Patient-Controlled Analgesia (IV PCA) in Postoperative Pain Management

Abstract: In this meta-analysis, fentanyl ITS is associated with a superior EOC profile from the nurses' perspective than morphine IV PCA.

Cited by 5 publications

References 24 publications

Comparison of fentanyl iontophoretic transdermal system and routine care with morphine intravenous patient-controlled analgesia in the management of early postoperative mobilisation: results from a randomised study

Comparison of fentanyl iontophoretic transdermal system and routine care with morphine intravenous patient-controlled analgesia in the management of early postoperative mobilisation: results from a randomised study

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

The Routes of Administration for Acute Postoperative Pain Medication

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