title: Patient-Controlled Fentanyl Iontophoretic Transdermal System Improved Postoperative Mobility Compared to Intravenous Patient-Controlled Analgesia Morphine: A Pooled Analysis of Randomized, Controlled Trials.
abstract: Postoperative pain management protocols that use patient-controlled analgesia (PCA) can hinder mobility due to attached machinery and tubing. Immobility in the postoperative setting can increase complications, length of stay (LOS), and costs. Early and enhanced mobilization can reduce the cost of care while improving patient outcomes. A needle-free, compact, patient-activated, and portable fentanyl iontophoretic transdermal system (fentanyl ITS, IONSYS; The Medicines Company, Parsippany NJ) has been shown to provide comparable efficacy and tolerability to intravenous (IV) PCA morphine that promotes improved mobility.
  
  
  
  This pooled analysis of 1,882 patients across three randomized, controlled trials compared fentanyl ITS to IV PCA morphine for postoperative pain management. Outcomes of patient mobility were assessed by a validated Patient Ease of Care Questionnaire that was given to patients, patients' nurses, and physical therapists involved in patient care. Safety was assessed via spontaneously reported treatment-emergent adverse events (TEAE).
  
  
  
  Fentanyl ITS significantly improved overall patient mobility, each mobility subscore (P < 0.0001) across all demographics (male/female; elderly/non-elderly; normal BMI/overweight/obese/morbidly obese) and surgery types, and was consistent across nurses and physical therapists mobility assessments. TEAEs were generally similar between the two groups. However, more patients reported an opioid-related TEAE with morphine IV PCA than with fentanyl IV PCA (P = 0.003).
  
  
  
  Due to improved mobility with fentanyl ITS, complications are expected to be less frequent than with IV PCA and epidural PCA. Incorporation of this strategy into postoperative pain management protocols may reduce LOS and total hospital costs.
authors.affiliation: Department of Orthopaedic Surgery, Marshall University, Huntington, West Virginia, U.S.A.
authors.forename: Ali
authors.initials: A
authors.lastname: Oliashirazi
authors.affiliation: Department of Orthopaedic Surgery, Marshall University, Huntington, West Virginia, U.S.A.
authors.forename: Timothy
authors.initials: T
authors.lastname: Wilson-Byrne
authors.affiliation: Department of Orthopaedic Surgery, Marshall University, Huntington, West Virginia, U.S.A.
authors.forename: Franklin D
authors.initials: FD
authors.lastname: Shuler
authors.affiliation: Department of Orthopaedic Surgery, The Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
authors.forename: Javad
authors.initials: J
authors.lastname: Parvizi
mesh_terms: D000279:Administration, Cutaneous; D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007478:Iontophoresis; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D009020:Morphine / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D011182:Postoperative Care / Q000295:instrumentation* / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine; D005283:Fentanyl
keywords: analgesia; ease of care; fentanyl; fentanyl iontophoretic transdermal system; iontophoretic transdermal system; mobility; pain; patient-controlled; pooled-analysis; postoperative