Jefferson-led study shows transdermal system as effective as IV pump for post-surgical pain

03/11/04

A needle-free, self-contained fentanyl patient-controlled transdermal system (PCTS) is as effective for post-surgical pain management as the traditional intravenous pump (IV), while giving patients more mobility and freeing nurses to devote more time to patient care. The study led by researchers from Jefferson Medical College of Thomas Jefferson University, Philadelphia, appears in the March 17 issue of the Journal of the American Medical Association (JAMA).

The multi-center study conducted at more than 30 sites nationwide demonstrated that a button-activated, fentanyl system that delivers pain medication through the skin could eliminate the need for IVs for post-surgical pain relief. The study was led by Eugene Viscusi, M.D., director of the Acute Pain Management Service at Thomas Jefferson University Hospital, Philadelphia. The fetanyl transdermal system would also offer the advantage of a needle-free, pre-programmed medication system in a small, self-contained unit.

"This is a miracle of miniaturization," said Dr. Viscusi, assistant professor of Anesthesiology, Jefferson Medical College of Thomas Jefferson University.

The system, known as E-TRANS fentanyl PCTS, is approximately the size of a credit card, self adherent to the skin, pre-programmed and needle free. It delivers pain medication across the skin with a low level electric current when activated by the patient with a small button on the surface of the device.

The fentanyl transdermal system could be used for patients with moderate to severe post-operative pain after most surgeries including joint replacement, prostate surgery or gynecological procedures, the Jefferson anesthesiologist said. "Anyone who has ever had surgery remembers the discomfort of having IVs and needles," Dr. Viscusi said. "This patch system has a huge potential advantage."

The PCTS, placed on an inpatient's upper arm or chest by adhesive on the back of the patch, transmits the pain medication through the skin at the push of a button, explained Dr. Viscusi. When the patient pushes the button for pain, PCTS delivers medication over 10 minutes. The system has a "lock out" feature so a patient cannot administer more pain medication than is prescribed for him. The system is replaced every 24 hours as needed.

Without any tubing or equipment to encumber a patient's movement, the patient can freely move about to perform needed physical therapy, Dr. Viscusi said.

The PTCS could also be a boon to nurses as nursing staff would not have to spend time setting up an IV and the time consuming standard pain pump currently used. This could allow nurses to devote more time to patient care instead of technology, he said.

The fentanyl patch system studied is currently under review by the U.S. Food and Drug Administration (FDA) and was developed by Ortho-McNeil Pharmaceuticals, Inc. and the ALZA Corporation, both subsidiaries of Johnson and Johnson.

Source: Eurekalert & others

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