Postoperative Pain Management With a Patient-Controlled Transdermal Delivery System for Fentanyl

Peter J. S. Koo


Am J Health Syst Pharm. 2005;62(11):1171-1176. 

In This Article

Comparison with Transdermal Fentanyl Patch

Fentanyl hydrochloride PCTS is differentiated from the Duragesic transdermal fentanyl patch by its pharmacokinetics, patient-controlled activation, and intended clinical use. The transdermal fentanyl patch continuously administers fentanyl via passive absorption and creates a subcutaneous depot of fentanyl, allowing for continued absorption of drug even after the patch is removed, resulting in a longer duration of action than with the i.v. formulation of fentanyl.[35,36] The mass of the subcutaneous reservoir of fentanyl 24 hours after application of a 100-µg/hr transdermal patch has been estimated to be 1.07 ± 0.43 mg, approximately 30% of the total dose delivered.[37] Studies of PCTS have shown that serum concentrations of fentanyl decline rapidly after it is removed from the skin in a manner similar to the decrease in serum fentanyl concentrations following the cessation of i.v. fentanyl treatment.[30] The duration of action of PCTS is similar to that of the i.v. formulation of fentanyl; thus, the depot effect is negligible. PCTS allows patients to control the amount of analgesic they receive; no such control is afforded by the passive transdermal fentanyl patch. Therefore, the patch is better suited for the management of chronic pain, whereas PCTS is more appropriate for acute pain.


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