Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-10T13:14:39.870Z Has data issue: false hasContentIssue false
  • English
  • Français

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
Get access

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Ballantyne, JC, Carr, DB, deFerranti, S et al. . The comparative effects of postoperative analgesic therapies on pulmonary outcome: cumulative meta-analyses of randomized, controlled trials. Anesth Analg 1998; 86: 598–612.CrossRefGoogle ScholarPubMed
2.Miaskowski, C, Crews, J, Ready, LB, Paul, SM, Ginsberg, B. Anesthesia-based pain services improve the quality of postoperative pain management. Pain 1999; 80: 23–29.Google Scholar
3.Beattie, WS, Badner, NH, Choi, P. Epidural analgesia reduces postoperative myocardial infarction: a meta-analysis. Anesth Analg 2001; 93: 853–858.Google Scholar
4.Rodgers, A, Walker, N, Schug, S et al. . Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomized trials. BMJ 2000; 321: 1493.CrossRefGoogle ScholarPubMed
5.Werner, MU, Soholm, L, Rotboll-Nielsen, P, Kehlet, H. Does an acute pain service improve postoperative outcome? Anesth Analg 2002; 95: 1361–1372, table.Google Scholar
6.International Association of the study of Pain, Task Force on Acute Pain. In: Ready, LB, Edwards, WT, eds. Management of Acute Pain: A Practical Guide. Seattle, WA: IASP Press, 1992.Google Scholar
7.Francesca, F, Bader, P, Echtle, D et al. . European Association of Urology guidelines on pain management. Eur Urol 2003; 44: 383–389.Google Scholar
8.Joint Commission on Accreditation of Healthcare Organizations. Pain Assessment and Management: An Organizational Approach . Oakbrook, IL: JCAHO, 2000.Google Scholar
9.Ashburn, MA, CaplanRA, Carr DB RA, Carr DB et al. American Society of Anesthesiologists Task Force on Acute Pain Management. Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology 2004; 100: 1573–1581.Google Scholar
10. Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine. Acute Pain Management: Scientific Evidence, 2nd edn, 2005. www.anzca.edu.au/publications/acutepain.htm.Google Scholar
11.Rawal, N. Organization, function, and implementation of acute pain service. Anesthesiol Clin North America 2005; 23: 211–225.CrossRefGoogle ScholarPubMed
12. Picker Institute Europe. Improving the quality of health care through the eyes of the patient. November 2002.www.pickereurope.org/Filestore/News/painnewsletternov02.pdf.2004.Google Scholar
13.Apfelbaum, JL, Chen, C, Mehta, SS, Gan, TJ. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg 2003; 97: 534–540.CrossRefGoogle ScholarPubMed
14.Dolin, SJ, Cashman, JN, Bland, JM. Effectiveness of acute postoperative pain management: I. Evidence from published data. Br J Anaesth 2002; 89: 409–423.CrossRefGoogle ScholarPubMed
15.Bertolini, G, Minelli, C, Latronico, N et al. . The use of analgesic drugs in postoperative patients: the neglected problem of pain control in intensive care units. An observational, prospective, multicenter study in 128 Italian intensive care units. Eur J Clin Pharmacol 2002; 58: 73–77.Google Scholar
16.Rawal, N, Allvin, R. Acute pain services in Europe: a 17-nation survey of 105 hospitals: the EuroPain Acute Pain Working Party. Eur J Anaesthesiol 1998; 15: 354–363.CrossRefGoogle ScholarPubMed
17.Persson, K, Ostman, M. The Swedish version of the PACU-Behavioural Pain Rating Scale: a reliable method of assessing postoperative pain? Scand J Caring Sci 2004; 18: 304–309.Google Scholar
18.Aubrun, F, Paqueron, X, Langeron, O, Coriat, P, Riou, B. What pain scales do nurses use in the postanaesthesia care unit? Eur J Anaesthesiol 2003; 20: 745–749.Google Scholar
19.Carr, DB, Miaskowski, C, Dedrick, SC, Williams, GR. Management of perioperative pain in hospitalized patients: a national survey. J Clin Anesth 1998; 10: 77–85.Google Scholar
20.Stamer, UM, Mpasios, N, Stuber, F, Maier, C. A survey of acute pain services in Germany and a discussion of international survey data. Reg Anesth Pain Med 2002; 27: 125–131.Google Scholar
21.Filos, KS, Lehmann, KA. Current concepts and practice in postoperative pain management: need for a change? Eur Surg Res 1999; 31: 97–107.CrossRefGoogle ScholarPubMed
22.Mann, E, Redwood, S. Improving pain management: breaking down the invisible barrier. Br J Nurs 2000; 9: 2067–2072.Google Scholar
23.Schafheutle, EI, Cantrill, JA, Noyce, PR. Why is pain management suboptimal on surgical wards? J Adv Nurs 2001; 33: 728–737.Google Scholar
24.Windsor, AM, Glynn, CJ, Mason, DG. National provision of acute pain services. Anaesthesia 1996; 51: 228–231.Google Scholar
25.Wilder-Smith, OH, Mohrle, JJ, Martin, NC. Acute pain management after surgery or in the emergency room in Switzerland: a comparative survey of Swiss anaesthesiologists and surgeons. Eur J Pain 2002; 6: 189–201.CrossRefGoogle ScholarPubMed
26.McDonnell, A, Nicholl, J, Read, SM. Acute Pain Teams in England: current provision and their role in postoperative pain management. J Clin Nurs 2003; 12: 387–393.Google Scholar
27.Puig, MM, Montes, A, Marrugat, J. Management of postoperative pain in Spain. Acta Anaesthesiol Scand 2001; 45: 465–470.Google Scholar
28.Trevisan, P, Gobber, G. Quality of post-anesthetic care in a hospital without a Post-Anesthetic Care Unit. A clinical audit. Minerva Anestesiol 2004; 70: 631–642.Google Scholar
29.Breivik, H. Postoperative pain management: why is it difficult to show that it improves outcome? Eur J Anaesthesiol 1998; 15: 748–751.CrossRefGoogle ScholarPubMed
30.Carr, DB, Goudas, LC. Acute pain. Lancet 1999; 353: 2051–2058.Google Scholar
31.Kehlet, H, Dahl, JB. Anaesthesia, surgery, and challenges in postoperative recovery. Lancet 2003; 362: 1921–1928.Google Scholar
32.Kehlet, H, Wilmore, DW. Multimodal strategies to improve surgical outcome. Am J Surg 2002; 183: 630–641.Google Scholar
33]Basse, L, Thorbol, JE, Lossl, K, Kehlet, H. Colonic surgery with accelerated rehabilitation or conventional care. Dis Colon Rectum 2004; 47: 271–277.Google Scholar
34.Brodner, G, Mertes, N, Buerkle, H, Marcus, MA, Van, AH. Acute pain management: analysis, implications and consequences after prospective experience with 6349 surgical patients. Eur J Anaesthesiol 2000; 17: 566–575.Google Scholar
35.Stomberg, MW, Wickstrom, K, Joelsson, H, Sjostrom, B, Haljamae, H. Postoperative pain management on surgical wards – do quality assurance strategies result in long-term effects on staff member attitudes and clinical outcomes? Pain Manag Nurs 2003; 4: 11–22.Google Scholar
36.Kampe, S, Kiencke, P, Krombach, J, Cranfield, K, Kasper, SM, Diefenbach, C. Current practice in postoperative epidural analgesia: a german survey. Anesth Analg 2002; 95: 1767–1769.Google Scholar
37.Powell, AE, Davies, HT, Bannister, J, Macrae, WA. Rhetoric and reality on acute pain services in the UK: a national postal questionnaire survey. Br J Anaesth 2004; 92: 689–693.Google Scholar
38.Sinatra, RS, Torres, J, Bustos, AM. Pain management after major orthopaedic surgery: current strategies and new concepts. J Am Acad Orthop Surg 2002; 10: 117–129.Google Scholar
39.Austrup, ML, Korean, G. Analgesic agents for the postoperative period opioids. Surg Clin North Am 1999; 79: 253–273.Google Scholar
40.Choiniere, M, Rittenhouse, BE, Perreault, S et al. . Efficacy and costs of patient-controlled analgesia versus regularly administered intramuscular opioid therapy. Anesthesiology 1998; 89: 1377–1388.Google Scholar
41.Ballantyne, JC, Carr, DB, Chalmers, TC, Dear, KB, Angelillo, IF, Mosteller, F. Postoperative patient-controlled analgesia: meta-analyses of initial randomized control trials. J Clin Anesth 1993; 5: 182–193.Google Scholar
42.Cupitt, JM, Kasipandian, V. Pain and intramuscular injections. Anaesthesia 2004; 59: 93.Google Scholar
43.Block, BM, Liu, SS, Rowlingson, AJ, Cowan, AR, Cowan, JA, JrWu, CL. Efficacy of postoperative epidural analgesia: a meta-analysis. JAMA 2003; 290: 2455–2463.CrossRefGoogle ScholarPubMed
44.Ganapathy, S, McCartney, CJ, Beattie, WS, Chan, VW. Best evidence in anesthetic practice: prevention: epidural anesthesia and analgesia does not reduce 30-day all-cause mortality and major morbidity after abdominal surgery. Can J Anaesth 2003; 50: 143–146.Google Scholar
45.Wu, CL, Anderson, GF, Herbert, R, Lietman, SA, Fleisher, LA. Effect of postoperative epidural analgesia on morbidity and mortality after total hip replacement surgery in medicare patients. Reg Anesth Pain Med 2003; 28: 271–278.Google Scholar
46.Ready, LB. Acute pain: lessons learned from 25,000 patients. Reg Anesth Pain Med 1999; 24: 499–505.Google Scholar
47.Andersen, G, Rasmussen, H, Rosenstock, C et al. . Postoperative pain control by epidural analgesia after transabdominal surgery. Efficacy and problems encountered in daily routine. Acta Anaesthesiol Scand 2000; 44: 296–301.Google Scholar
48.Dawson, S. Epidural catheter infections. J Hosp Infect 2001; 47: 3–8.CrossRefGoogle ScholarPubMed
49]Moen, V, Dahlgren, N, Irestedt, L. Severe neurological complications after central neuraxial blockades in Sweden 1990-1999. Anesthesiology 2004; 101: 950–959.Google Scholar
50.Austin, J. Provision of postoperative epidural services in NHS hospitals. Anaesthesia 2002; 57: 778–784.Google Scholar
51.O'Higgins, F, Tuckey, JP. Thoracic epidural anaesthesia and analgesia: United Kingdom practice. Acta Anaesthesiol Scand 2000; 44: 1087–1092.Google Scholar
52.Ben-David, B. Complications of regional anesthesia: an overview. Anesthesiol Clin North America 2002; 20: 665–667.Google Scholar
[53]Chumbley, GM, Hall, GM, Salmon, P. Why do patients feel positive about patient-controlled analgesia? Anaesthesia 1999; 54: 386–389.Google Scholar
54.Walder, B, Schafer, M, Henzi, I, Tramer, MR. Efficacy and safety of patient-controlled opioid analgesia for acute postoperative pain. A quantitative systematic review. Acta Anaesthesiol Scand 2001; 45: 795–804.Google Scholar
55.Vicente, KJ, Kada-Bekhaled, K, Hillel, G, Cassano, A, Orser, BA. Programming errors contribute to death from patient-controlled analgesia: case report and estimate of probability. Can J Anaesth 2003; 50: 328–332.Google Scholar
56.Neugebauer, E, Sauerland, S, Keck, V, Simanski, C, Witte, J. Surgical pain management. A Germany-wide survey including the effect of clinical guidelines. Chirurg 2003; 74: 235–238.Google Scholar
57.Gan, TJ, Joshi, GP, Zhao, SZ, Hanna, DB, Cheung, RY, Chen, C. Presurgical intravenous parecoxib sodium and follow-up oral valdecoxib for pain management after laparoscopic cholecystectomy surgery reduces opioid requirements and opioid-related adverse effects. Acta Anaesthesiol Scand 2004; 48: 1194–1207.Google Scholar
58.Stubhaug, A, Breivik, H, Eide, PK, Kreunen, M, Foss, A. Mapping of punctuate hyperalgesia around a surgical incision demonstrates that ketamine is a powerful suppressor of central sensitization to pain following surgery. Acta Anaesthesiol Scand 1997; 41: 1124–1132.Google Scholar
59.Seib, RK, Paul, JE. Preoperative gabapentin for postoperative analgesia: a meta-analysis. Can J Anaesth 2006; 53: 461–469.Google Scholar
60.Peng, PW, Sandler, AN. A review of the use of fentanyl analgesia in the management of acute pain in adults. Anesthesiology 1999; 90: 576–599.CrossRefGoogle ScholarPubMed
61.Striebel, HW, Touissant, S, Raab, C, Klocker, N. Non-invasive methods for PCA in pain management. Acute Pain 1999; 2: 36–40.CrossRefGoogle Scholar
62.Sathyan, G, Zomordi, K, Gidwani, S, Gupta, S. The effect of dosing frequency on the pharmacokinetics of fentanyl HCl patient-controlled transdermal system (PCTS). Clin Pharmacokinet 2005; 44 (Suppl 1): 17–24.CrossRefGoogle ScholarPubMed
63.Sathyan, G, Jaskowiak, J, Evashenk, M, Gupta, S. Characterisation of the pharmacokinetics of fentanyl HCl patient-controlled transdermal system (PCTS): effect of current magnitude and multiple-day dosing, and comparison with IV fentanyl administration. Clin Pharmacokinet 2005; 44 (Suppl 1): 7–15.Google Scholar
64. Brown CR, Moodie JE, Bisley EJ. Safety and efficacy of Transfenta in the treatment of post-operative pain: a double-blind, single-center, placebo-controlled trial. 17th Annual Scientific Meeting of the American Pain Society, November 5–8, 1998, San Diego, Calif 1998; 192. Abstract 886.Google Scholar
65.Chelly, JE, Grass, J, Houseman, TW, Minkowitz, H, Pue, A. The safety and efficacy of a fentanyl patient-controlled transdermal system for acute postoperative analgesia: a multicenter, placebo-controlled trial. Anesth Analg 2004; 98: 427–433.Google Scholar
66.Viscusi, ER, Reynolds, L, Tait, S, Melson, T, Irani, H, Atkinson, LE. An iontophoretic fentanyl patient-controlled analgesic delivery system for postoperative pain: a double-blind, placebo-controlled trial. Anesth Analg 2006; 102: 188–194.Google Scholar
67.Viscusi, ER, Reynolds, L, Chung, F, Atkinson, LE, Khanna, S. Patient-controlled transdermal fentanyl hydrochloride vs. intravenous morphine pump for postoperative pain: a randomized controlled trial. JAMA 2004; 291: 1333–1341.Google Scholar
68.Chelly, JE. An iontophoretic, fentanyl HCl patient-controlled transdermal system for acute postoperative pain management. Expert Opin Pharmacother 2005; 6: 1205–1214.Google Scholar
69.Parker, RK, Holtmann, B, White, PF. Patient-controlled analgesia. Does a concurrent opioid infusion improve pain management after surgery? JAMA 1991; 266: 1947–1952.Google Scholar
70.Macintyre, PE. Safety and efficacy of patient-controlled analgesia. Br J Anaesth 2001; 87: 36–46.CrossRefGoogle ScholarPubMed
71.Good, KK, Verble, JA, Secrest, J, Norwood, BR. Postoperative hypothermia--the chilling consequences. AORN J 2006; 83: 1055–1066.CrossRefGoogle ScholarPubMed