title: Fentanyl iontophoretic transdermal system versus morphine intravenous patient-controlled analgesia for pain management following gynecological surgery: a meta-analysis of randomized, controlled trials.
abstract: OBJECTIVE
  To compare the efficacy and safety of patient-controlled fentanyl iontophoretic transdermal system (ITS) with morphine intravenous (i.v.) patient-controlled analgesia (PCA) for pain management following gynecological surgery.
  
  
  METHODS
  Two-open-label, multicenter, randomized, active-controlled, parallel-group studies (n = 1142) were conducted that compared fentanyl ITS with morphine iv. PCA for postoperative pain. The subgroup of gynecological surgery patients from each trial was utilized for this meta-analysis (n = 604). Of these patients, 295 received fentanyl ITS (40 μg/dose) and 309 received morphine i.v. PCA (1 mg/dose) for up to 72 h. Efficacy measures included the patient global assessment (PGA) and the investigator global assessment (IGA) of the method of pain control.
  
  
  RESULTS
  Gynecological surgery patients (n = 604) included in this meta-analysis had a mean age of 45 years, were predominantly Caucasian (65%) and had a mean body mass index of 29 mg/kg2. There were statistically significantly more patients treated with fentanyl ITS and more investigators who rated their pain control method as 'excellent' on the PGA at 24 h (49.3 vs 37.4%, respectively; p = 0.0029) and IGA at the last assessment (59.5 vs. 38.0%, respectively; p < 0.0001), respectively, compared with morphine iv. PCA at the last assessment.
  
  
  CONCLUSIONS
  Following gynecological surgery, patients and investigators were more satisfied (had a higher percent of an 'excellent' rating on the PGA and IGA, respectively) with fentanyl ITS than morphine iv. PCA as a method of pain control.
authors.affiliation: West Coast Ob/Gyn Inc., San Diego, CA 92123, USA.
authors.forename: Craig S
authors.initials: CS
authors.lastname: Saffer
authors.affiliation: Department of Anesthesiology, Memorial Hermann Memorial City Medical Center, Houston, TX 77024, USA.
authors.forename: Harold S
authors.initials: HS
authors.lastname: Minkowitz
authors.affiliation: The Medicines Company, Parsippany, NJ 07054, USA.
authors.forename: Li
authors.initials: L
authors.lastname: Ding
authors.affiliation: The Medicines Company, Parsippany, NJ 07054, USA.
authors.forename: Hassan
authors.initials: H
authors.lastname: Danesi
authors.affiliation: The Medicines Company, Parsippany, NJ 07054, USA.
authors.forename: James B
authors.initials: JB
authors.lastname: Jones
mesh_terms: D000279:Administration, Cutaneous; D061605:Administration, Intravenous; D000328:Adult; D016058:Analgesia, Patient-Controlled / Q000295:instrumentation / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use*; D013509:Gynecologic Surgical Procedures; D006801:Humans; D007478:Iontophoresis / Q000379:methods; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D017060:Patient Satisfaction; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine; D005283:Fentanyl
keywords: fentanyl; gynecologic surgery; intravenous; iontophoretic transdermal system; morphine; patient-controlled analgesia; postoperative pain