Fentanyl Iontophoretic Transdermal System for Acute-Pain Management After Orthopedic Surgery: A Comparative Study With Morphine Intravenous Patient-Controlled Analgesia

2006 ◽  
Vol 31 (6) ◽  
pp. 546-554 ◽  
Author(s):  
C HARTRICK ◽  
M BOURNE ◽  
K GARGIULO ◽  
C DAMARAJU ◽  
S VALLOW ◽  
...  
Keyword(s):  
Pain Management ◽  
Comparative Study ◽  
Acute Pain ◽  
Orthopedic Surgery ◽  
Patient Controlled Analgesia ◽  
Acute Pain Management ◽  
Iontophoretic Transdermal System

A patient-activated iontophoretic transdermal system for acute pain management with fentanyl hydrochloride: Overview and applications

2006 ◽  
Vol 2 (6) ◽  
pp. 314 ◽  
Author(s):  
Kevin T. Bain, PharmD, BCPS, CGP, FASCP
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Acute Pain ◽  
Medication Administration ◽  
Patient Controlled Analgesia ◽  
Acute Postoperative Pain ◽  
Acute Pain Management ◽  
Free System ◽  
Opioid Administration ◽  
Iontophoretic Transdermal System

Opioid administration by patient-controlled analgesia (PCA) is the standard therapy for acute postoperative pain. Despite its utility in this setting, limitations of this modality do exist. Consequently, noninvasive PCA systems, including an iontophoretic transdermal system (ITS) with fentanyl hydrochloride, are under development to circumvent many of these limitations. This preprogram med, self-contained, compact, needle-free system provides pain con trol superior to that of placebo and comparable to morphine PCA in the first 24 hours after major surgical procedures. The objectives of this article are to describe the method of transdermal iontophoretic medication administration and to review the literature pertaining to the fentanyl ITS.

Fentanyl Iontophoretic Transdermal System for Acute-Pain Management After Orthopedic Surgery

2006 ◽  
Vol 31 (6) ◽  
pp. 546-554 ◽  
Author(s):  
Craig T. Hartrick ◽  
Michael H. Bourne ◽  
Kathryn Gargiulo ◽  
C. V. Damaraju ◽  
Sue Vallow ◽  
...  
Keyword(s):  
Pain Management ◽  
Acute Pain ◽  
Orthopedic Surgery ◽  
Acute Pain Management ◽  
Iontophoretic Transdermal System

Fentanyl iontophoretic transdermal system versus morphine intravenous patient-controlled analgesia for pain management following orthopedic surgery: A pooled analysis of randomized, controlled trials

2016 ◽  
Vol 12 (1) ◽  
pp. 37 ◽  
Author(s):  
Craig T. Hartrick, MD ◽  
Donald M. Knapke, MD ◽  
Li Ding, MS, MA ◽  
Hassan Danesi, MD ◽  
James B. Jones, MD
Keyword(s):  
Pain Management ◽  
Orthopedic Surgery ◽  
Pain Control ◽  
Global Assessment ◽  
Control Method ◽  
Pooled Analysis ◽  
Patient Controlled Analgesia ◽  
Open Label ◽  
Parallel Group ◽  
Iontophoretic Transdermal System

Objective: To compare the efficacy and safety of patient-controlled pain management following orthopedic surgery using either fentanyl iontophoretic transdermal system (ITS) or morphine intravenous (IV) patient-controlled analgesia (PCA).Setting: Acute Care Hospital.Patients: Three-open-label, multicenter, randomized, active-controlled, parallel-group phase 3B studies (N = 2095) were conducted that compared fentanyl ITS with morphine IV PCA for postoperative pain in hospitalized postoperative patients. A subgroup of orthopedic surgery patients (N = 1,216) was pooled for this analysis; of which 819 completed treatment.Interventions: A total of 590 patients received fentanyl ITS (40 μg/dose) and 626 patients received morphine IV PCA (1 mg/dose) for up to 72 hours.Main outcome measures: Efficacy measures included the patient global assessment (PGA) and the investigator global assessment (IGA) of the method of pain control.Results: Patients had a mean age of about 60 years, were predominantly Caucasian (90.5 percent), and the majority underwent hip replacement (80.3 percent). There were more patients treated with fentanyl ITS who rated their pain control method as “excellent” compared to morphine IV PCA at 24 hours postsurgery (44.8 percent vs 33.0 percent, respectively; p < 0.001), 48 hours (37.5 percent vs 25.3 percent, respectively; p < 0.001), and at the last assessment (54.3 percent vs 39.6 percent, respectively; p < 0.001). There were more investigators who rated treatment with fentanyl ITS as “excellent” compared to morphine IV PCA at the last assessment (57.4 percent vs 36.9 percent, respectively; p < 0.001).Conclusions: Following orthopedic surgery, patients and investigators more frequently reported global assessment of pain control as “excellent” on the PGA and IGA assessments with fentanyl ITS than with morphine IV PCA.

Multimodal Approach to Acute Pain Management after Nuss Bar Placement and Other Pain Scenarios

2018 ◽  
Author(s):  
Christina D. Diaz ◽  
Steven J. Weisman
Keyword(s):  
Pain Management ◽  
Acute Pain ◽  
Behavioral Modification ◽  
Patient Controlled Analgesia ◽  
Acute Pain Management ◽  
Nerve Blocks ◽  
Pain Medications ◽  
Oral Pain ◽  
Inflammatory Drugs ◽  
Oral Pain Medication

Acute pain management can involve regional blocks with local anesthetics, neuraxial blocks such as caudal blocks and epidurals, oral and intravenous opioids, and nonsteroidal anti-inflammatory drugs. Other pain management modalities include neuropathic pain medications, muscle relaxants, antidepressants, acupuncture, techniques for stress relief, and behavioral modification therapy. While there are many options for treating a patient’s pain, the best approach is to understand the symptoms, attempt to determine the cause of the pain, and understand the patient’s goals with regard to treatment. This chapter discusses the multimodal acute pain management for a case of Nuss bar placement, utilizing an epidural, patient-controlled analgesia, and oral pain medication. The chapter has an additional scenario discussing neuraxial analgesia and nerve blocks for a hypospadias repair in an infant. Finally, the third case-based discussion focuses on the treatment of common types of headaches.

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