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System-related events and analgesic gaps during postoperative pain management with the fentanyl iontophoretic transdermal system and morphine intravenous patient-controlled analgesia



System-related events and analgesic gaps during postoperative pain management with the fentanyl iontophoretic transdermal system and morphine intravenous patient-controlled analgesia



Anesthesia and Analgesia 105(5): 1437-41



Analgesic gaps (interruptions in analgesic delivery) contribute to ineffective postoperative pain management. In this analysis, we evaluated the incidence of analgesic gaps resulting from system-related events (SREs) for patients using the fentanyl iontophoretic transdermal system (ITS), a noninvasive patientcontrolled analgesia (PCA) system, or morphine IV PCA for postoperative pain management. METHODS: Data were pooled from two open-label, randomized, active-controlled System-Related Events and Analgesic Gaps During Postoperative Pain Management with the Fentanyl lontophoretic Transdermal System and Morphine Intravenous Patient-Controlled Analgesiatrials that evaluated the efficacy and safety of fentanyl ITS a nd morphine IV PCA after total hip replacement, abdominal, or pelvic surgery. The incidence and duration of analgesic gaps resulting frorn SREs were assessed, along with SRE resolution times. RESULTS: A total of 1305 patients received fentanyl ITS (n = 647) or morphine TV PCA (n = 658). Fentanyl ITS was associated with a significantly lower incidence of analgesic gaps per 100 patients compared with morphine IV PCA (5.87 vs 12.01, respectively; P < 0.001). Compared with patients receiving morphine IV PCA, patients receiving fentanyl ITS had both a numerically lower median total analgesic gap time (15.0 min vs 20.0 min) and a numerically lower median total SRE resolution time (11.0 min vs 20.0 min). Most fentanyl ITS SREs were resolved by applying a new system, whereas many different SRE resolution methods were used for morphine IV PCA. CONCLUSIONS: Fentanyl ITS was associated with a significantly lower incidence of analgesic gaps relative to morphine IV PCA. Fentanyl ITS may provide patients with fewer interruptions and more continuous analgesic delivery. (Anesth Analg 2007;105:1437-41)

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Accession: 056090427

Download citation: RISBibTeXText

PMID: 17959979

DOI: 10.1213/01.ane.0000281442.36582.81


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