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 fentanyl PCTS and 76.9 percent of patients who received IV PCA morphine.
"Early patient discontinuations (25.9 percent fentanyl vs. 25.0 percent morphine) and last pain intensity scores (32.7 fentanyl vs. 31.1 morphine on the visual analog scale) were not different between the 2 treatments. With continued treatment for up to 48 or 72 hours, more than 80 percent of patient assessments in each treatment group were good or excellent. The incidence of opioid-related adverse events was similar between the groups," the researchers write.
(JAMA. 2004;291:1333-1341. Available post-embargo at JAMA.com)
Editor's Note: ALZA Corporation, Mountain View, Calif., supported the study in its entirety. Co-authors Drs. Atkinson and Khanna own stock in Johnson & Johnson, the parent company of Alza Corporation.
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JAMA