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

Peter J. S. Koo

Disclosures

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

In This Article

Potential Therapeutic Applications

Current options for managing acute postoperative pain include PCA, regional anesthesia, and epidural analgesia, among others. PCA is the most commonly used of these modalities, and it would be expected that PCTS could be used in postoperative situations in which PCA is currently administered, given that the two modalities have been shown to be therapeutically equivalent.[34] In addition to the potential for improved patient mobility and lack of exposure to programming errors, PCTS may offer other benefits, including potential safety advantages owing to its preprogrammed, noninvasive delivery mechanism.

Appropriate selection of patients is necessary for optimal pain control with PCTS; current practice dictates that patients using PCA for pain control should be awake, alert, and able to understand how to use the device; the same requirements would need to be met for PCTS. In addition, there are certain aspects of PCTS, including preprogrammed dosages and lack of the ability to deliver a background infusion, that may render it unsuitable for some patients, such as opioid-dependent patients and others who are expected to have a high requirement for postoperative opioids. The lack of a background infusion could potentially result in breakthrough pain. However, patients appear to receive adequate analgesia with the available range of fentanyl hydrochloride dosages (40-240 µg/hr); a majority of patients gave themselves fewer than two doses per hour after the first three hours of treatment.a

Economic considerations will most likely affect the clinical use of PCTS. Accurate assessment of the cost of currently available therapies will be necessary for comparison with PCTS. A complete assessment should account for such factors as the staffing resources necessary for administration, the cost associated with the relative invasiveness of each modality, and the impact of therapy on such outcomes as length of stay, patient satisfaction, and quality of life. These considerations will become more important as PCTS enters the market and information on projected costs becomes available.

It is possible that PCTS may have therapeutic applications outside postoperative pain management, such as for breakthrough pain in cancer patients, pain control after outpatient surgery, and pain crises in sickle cell anemia patients. These uses have yet to be investigated in controlled clinical trials, so they cannot currently be recommended.

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