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Transdermal patch as effective as intravenous pump for post-op pain control

Use of a transdermal patch to deliver pain medication was found to be equivalent to medication delivered by an intravenous pump for controlling pain following surgery, according to a study in the March 17 issue of The Journal of the American Medical Association (JAMA).

Patient-controlled analgesia (PCA) allows the patient to self-administer small doses of opioids, such as fentanyl and morphine, as needed to control pain, according to background information in the article. PCA with an intravenous (IV) pump with morphine is a common method of providing postoperative pain control after major surgery. The fentanyl hydrochloride patient-controlled transdermal system (PCTS) eliminates the need for the use of needles, intravenous tubing, a large pump, and does not hinder mobility. The transdermal system is a self-adhesive unit, about the size of a credit card, and is worn on the patient's upper arm or chest. It delivers small doses of fentanyl into the skin, where it then diffuses into the local circulation and is transported to the central nervous system.

Eugene R. Viscusi, M.D., of Thomas Jefferson University, Philadelphia, and colleagues conducted a study to determine whether the transdermal PCA delivery system is equivalent to a standard morphine IV PCA regimen in postoperative pain management. The trial included 636 adult patients who had just undergone major surgery between September 2000 and March 2001 at 33 North American hospitals. In surgical recovery rooms, patients were randomly assigned to intravenous morphine by a patient-controlled analgesia pump (n = 320) or fentanyl hydrochloride by a patient-controlled transdermal system (n = 316).

The researchers found that fentanyl hydrochloride PCTS and IV PCA morphine were equivalent according to the primary end point of ratings of pain control during the first 24-hour treatment period. Ratings of good or excellent pain control were reported by 73.7 percent of patients who received fentan
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Contact: Jeffrey Baxt
215-955-5507
JAMA and Archives Journals
16-Mar-2004


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