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Current practices for postoperative pain management in Europe and the potential role of the fentanyl HCl iontophoretic transdermal system

Published online by Cambridge University Press:  01 April 2007

N. Rawal  and
R. M. Langford
N. Rawal
Affiliation:
Örebro University Hospital, Department of Anaesthesiology and Intensive Care, Örebro, Sweden
R. M. Langford
Affiliation:
St. Bartholomew’s Hospital, Anaesthetic Laboratory, London, UK
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Summary

Survey results continue to reveal that postoperative pain is insufficiently managed throughout Europe and the rest of the world. However, the efficient use of existing resources, as well as the introduction of novel technologies, may aid in its improvement. Use of an acute pain service has the potential to improve pain management through specialized patient care and utilization of effective analgesic techniques. Multimodal analgesic techniques, which include adjuvant non-opioids and/or regional analgesic techniques, can provide effective analgesia and reduce the amount of systemic opioids (or obviate the need) for postoperative pain management. Patient-controlled analgesia modalities may also offer improvements to pain management, as in practice they provide pain relief superior to the intermittent administration of bolus doses of opioids. A novel patient-controlled analgesia modality that has been approved by the European Medicines Evaluation Agency (EMEA) for the treatment of acute, moderate-to-severe pain is the needle-free, pre-programmed fentanyl HCl iontophoretic transdermal system. This system was shown in a recent US clinical trial to be comparable in efficacy to a standard regimen of morphine intravenous patient-controlled analgesia. Adverse events associated with the use of the fentanyl iontophoretic transdermal system are generally similar to those experienced by patients using intravenous morphine patient-controlled analgesia. Considerations regarding the selection of patients for treatment with the fentanyl iontophoretic transdermal system are similar to those with other patient-controlled analgesia modalities; sufficient upper limb mobility and alertness are required to operate the system. Utilization of the fentanyl iontophoretic transdermal system, together with the guidance of an effective acute pain service, may lead to improvements in postoperative pain management.

Keywords

PAIN, postoperativeANAESTHETIC TECHNIQUES, patient-controlled analgesiaiontophoresisANALGESIC, fentanylHEALTH SERVICE, acute pain service
Type
Review Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 4 , April 2007 , pp. 299 - 308
Copyright
Copyright © European Society of Anaesthesiology 2006

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