Inadequate
pain control in the postoperative period not only contributes to patient discomfort, but also causes physiological changes that may result in increased risk of myocardial ischaemia,
deep vein thrombosis and
pulmonary embolism. These events complicate postoperative recovery and may lead to longer
hospital stays as well as increased healthcare costs.
Patient-controlled analgesia (PCA) has emerged as an effective way for patients to manage their
pain, allowing
self-administration of small doses of
analgesics to maintain a certain level of
pain control. PCA is most commonly delivered via an intravenous (IV) or epidural route, and while patient satisfaction is higher with PCA than with conventional methods of
analgesic administration, the invasiveness, costs and risk of errors associated with currently available modalities may limit their utility. These systems also require significant healthcare resources, as nurses must manually program the pumps to deliver the correct amount of medication. Several new PCA modalities are being developed to address these limitations. These systems deliver
drug through a variety of routes, including nasal transmucosal and transdermal. Most notably, a self-contained, credit card-sized, transdermal PCA system is currently in the final stages of development. The
fentanyl HCl patient-controlled transdermal system (PCTS; IONSYS, Ortho-McNeil
Pharmaceutical, Inc., Raritan, NJ) uses an imperceptible, low-intensity direct current to transfer
fentanyl on demand across the skin into the systemic circulation. This compact system is patient-activated, can be applied to the patient's upper arm or chest, and is designed to manage moderate-to-severe
pain requiring
opioid analgesia. The system delivers a preprogrammed amount of
fentanyl HCI over 10 minutes, for a total of 80 doses, or for 24 hours, whichever occurs first. The on-demand dosing and pharmacokinetics of this system differentiate it from the passive transdermal formulation of
fentanyl designed for the management of chronic
pain. Clinical studies have shown that the
fentanyl HCl PCTS is effective in the management of
acute postoperative pain. These studies have also demonstrated that the system is safe and well tolerated by patients.