Postoperative pain, fentanyl transdermal system

Dosages and routes of administration For acute (postoperative) pain and for anesthesia, fentanyl is given by the intravenous route. For pre-medication in anesthesia and for break-through pain the compound can also been given as an oral-transmucosal formulation (Ashburn and Streisand, 1994). A transdermal patch has been developed for chronic pain treatment (Jeal and Benfield, 1997 O Siordin, 1998). The intravenous doses for premedication are 50-100 pg, oral-transmucosal systems contain 200-400 pg and patch formulations have a delivery rate of 25-100 pg/h. 

Transdermal systems with electrophoretic release of the active substance are under development, e.g. ETRANS by ALZA with fentanyl for postoperative pain in clinical phase III. By virtue of the electrical field administration of the active substance is faster and on demand, e.g. similar to PCA therapy. 

ChellyJE. An iontophoretic, fentanyl HC1 patient-controlled transdermal system for acute postoperative pain management. Expert Opin Pharmacother. 2005 6 1205-1214. 

Koo PJ. Postoperative pain management with a patient-controlled transdermal delivery system for fentanyl. Am J Health Syst Pharm. 2 00 5 62 1171-1176. 

Fentanyl transdermal delivery systems (FTDS) use an unsealed multilaminate system containing a solid matrix, in which fentanyl is embedded instead of the reservoir designed in the TTS. FTDS is not to be recommended for routine postoperative pain treatment, even though it has a faster onset of action (4—6 hours) after cases of fentanyl toxicity, especially respiratory depression. FTDS has not been investigated adequately in chronic pain and is not expected to be superior to the TTS technique. 

Ranchal SJ, Damaraju CV, Nelson WW, Hewitt DJ, Schein JR. System-related events and analgesic gaps during postoperative pain management with the fentanyl iontophoretic transdermal system and morphine intravenous patient-controUed analgesia. Anesth Anal 2007 105(5) 1437-1441. 

Poon K-H, Tan K-H, Ho K-Y. Efficacy of fentanyl iontophoretic transdermal system in postoperative pain—a meta-analysis. Acute Pain 2009 11(2) 65-74. 

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