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.

PURPOSE: The aim of this meta-analysis was to compare the ease of care (EOC) of fentanyl iontophoretic transdermal system (ITS) vs the morphine intravenous patient-controlled analgesia (IV PCA) as assessed by the nurse. DESIGN: Meta-analysis of three phase 3B randomized active-comparator trials. METHODS: This meta-analysis according to Cochrane's approach assessed EOC using a validated nurse questionnaire (22 items grouped into three subscales, which include time efficiency, convenience, and satisfaction) in adult patients treated with fentanyl ITS or morphine IV PCA for postoperative pain management. The weighted mean difference (WMD) between treatments was calculated. FINDING: EOC analyses were based on responses to questionnaires from 848 (fentanyl ITS) and 761 (morphine IV PCA) nurses. Fentanyl ITS was reported to provide significant advantages compared with morphine IV PCA in terms of nurses' overall EOC (WMD = -0.57, P < .0001) and each of the subscales: time efficiency (WMD = -0.58, P < .0001), convenience (WMD = -0.57, P < .0001), and satisfaction (WMD = -0.47, P < .0001). CONCLUSIONS: In this meta-analysis, fentanyl ITS is associated with a superior EOC profile from the nurses' perspective than morphine IV PCA.

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

Opioids are commonly used in the management of moderate-to-severe postoperative pain. Patient-controlled analgesic techniques are recognized as preferred administration methods. Previously, research has focused on intravenously administered opioids via a programmable pump. More recently, an iontophoretic transdermal system (ITS), which is patient controlled, has been developed. The focus of this review is on pain management using the fentanyl ITS during the 24-72-hour time period immediately following surgery. Fentanyl ITS offers a needle-free alternative to traditional intravenous (IV) patient-controlled analgesia (PCA) system that is as effective and safe as IV PCA. This system is easy to use for both patients and nurses. The use of fentanyl ITS is generally associated with a better ease-of-care profile, including a greater ease of mobility, from a patients' perspective when compared with morphine IV PCA.

Comparison of postoperative pain management using two patient-controlled analgesia methods: nursing perspective.

AIM: To compare the effect of fentanyl iontophoretic transdermal system and morphine intravenous patient-controlled analgesia on the time-efficiency and convenience of postoperative patient care. BACKGROUND: Intravenous patient-controlled analgesia with morphine is effectively used to manage postoperative pain; however, it takes time to set up and administer. METHODS: Nurses evaluated patient-care tasks with fentanyl iontophoretic transdermal system and/or morphine intravenous patient-controlled analgesia in two phase IIIb studies (n = 1305) using a nurse ease-of-care questionnaire. A responder for time-efficiency and convenience responded with one of the top three positive choices on all items; for satisfaction, a responder chose one of the top two positive choices on both items. Data were collected between March 2004 and April 2005. FINDINGS: In both studies, greater proportions of nurses were responders for fentanyl iontophoretic transdermal system than for morphine intravenous patient-controlled analgesia, respectively, for time-efficiency [total hip replacement surgery, 80.9% (250/309) vs. 57.7% (172/298), P < 0.001; abdominal/pelvic surgery, 84.8% (162/191) vs. 57.7% (113/196), P < 0.001], convenience [total hip replacement surgery, 85.5% (271/317) vs. 64.1% (191/298), P < 0.001; abdominal/pelvic surgery, 89.2% (166/186) vs. 62.8% (123/196), P < 0.001], and satisfaction [total hip replacement surgery, 66.6% (247/371) vs. 33.3% (108/324), P < 0.001; abdominal/pelvic surgery, 67.4% (155/230) vs. 38.2% (84/220), P < 0.001]. Higher proportions of nurses favoured fentanyl iontophoretic transdermal system than morphine intravenous patient-controlled analgesia in both studies (P < 0.001). CONCLUSION: The fentanyl iontophoretic transdermal system appears to be simpler, easier to use, and more satisfactory for nurses than morphine intravenous patient-controlled analgesia.