Fentanyl iontophoretic transdermal system for acute-pain management after orthopedic surgery: A comparative study with morphine intravenous patient-controlled analgesia

The Influence of Anesthesia and Pain Management on Cognitive Dysfunction After Joint Arthroplasty: A Systematic Review

“…Inan et al [20] found no difference in postoperative cognitive dysfunction with the use of epidural versus IV PCA morphine and Colwell and Morris [7] reported no difference in complications, including confusion, with the use of IV PCA versus IM morphine postoperatively. However, Hartrick et al [16] and Herrick et al [18] reported a higher incidence of postoperative cognitive dysfunction with the use of morphine PCA as compared to fentanyl PCA, and Ilahi et al [19] found a higher incidence of postoperative cognitive dysfunction with the use of continuous epidural morphine as compared to fentanyl (23% versus 8%; p = 0.019). Leung et al [29] found that IV PCA was associated with a higher risk of postoperative cognitive dysfunction as compared to oral narcotics (odds ratio [OR]: 3.75; 95% CI: 1.27-11.01), as was postoperative benzodiazepine use (OR: 2.29; 95% CI: 1.21-4.36).…”

“…However, of those studies, only nine of 21 (43%) explicitly reported blinding of patients, clinicians, and/or assessors to the participants' treatment arm allocation [4,12,15,20,24,27,29,47,48]. Only nine of 21 (43%) reported performing an a priori power calculation for the outcome of postoperative cognitive dysfunction [4,16,24,27,29,34,38,39,48], with one of these studies failing to recruit a sufficient number of patients [38]. Of the remaining seven studies, two used a prospective comparative design [2,41], two used a case-control design [33,44], and three used a retrospective comparative design [17,19,36].…”

“…This included eight studies of patients who underwent either TKA or THA [7,12,17,18,20,24,36,47], eight studies of patients who underwent unilateral TKA [15,19,26,35,39,41,45,48], two studies of patients who underwent unilateral THA [16,34], and one study of patients who underwent bilateral TKA [46]. The remaining nine studies encompassing 2426 patients investigated postoperative cognitive dysfunction in a mixed major noncardiac surgical population, which included patients who underwent elective joint arthroplasty.…”

Optimizing pain management to facilitate Enhanced Recovery After Surgery pathways

“…Apart from greater ease of administration and patient comfort, a recent review showed fewer opioid-related adverse events and pain control comparable with intravenous opioids. 113 Future implications for research include its efficacy and optimal dose in different patient populations (e.g., by age, body weight, and surgery type) as well as the duration and severity of reactions at the application site. 114 …”

Meta-analysis of the efficacy of the fentanyl iontophoretic transdermal system versus intravenous patient-controlled analgesia in postoperative pain management

“…The efficacy and safety of fentanyl ITS in postoperative pain management has been established in four 72-h activecontrolled RCTs, which were based on a comparison with morphine intravenous patient-controlled analgesia (IV PCA) [5][6][7][8]. We have previously reported results using a simple pooled analysis of three of the four Phase III active comparator clinical trials that compared fentanyl ITS with morphine IV PCA [9].…”