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Title: Transdermal Fentanyl Tops IV Morphine in Hip Replacement Surgery: Presented at AAOS

"Transdermal Fentanyl Tops IV Morphine in Hip Replacement Surgery: Presented at AAOS"

By Jill Stein SAN DIEGO, CA -- February 14, 2007 -- Fentanyl iontophoretic transdermal system (ITS) is associated with better mobility and ease of care (EOC) than morphine IV patient-controlled analgesia after hip replacement surgery, researchers reported here at the 2007 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS). Michael Bourne, MD, orthopaedic surgeon, Salt Lake Orthopaedic Clinic/Life Tree Clinical Research, Salt Lake City, Utah, and colleagues analyzed pooled data from 2 randomized, controlled trials that evaluated the 2 modalities for managing acute postoperative pain after unilateral total hip replacement in 909 patients. "Acute postoperative pain following unilateral total hip replacement, one of the most common ambulatory orthopedic procedures, is often difficult to manage," Dr. Bourne said in a poster presentation on February 14[^th.

The researchers used the Patient EOC Questionnaire, which evaluates the ease of use of the pain control method. Overall EOC was calculated as the mean of scores on several subscales, including the Movement, Confidence with Device, Comfort with Device, Dosing Confidence, Pain Control, and Knowledge/Understanding of the Device.

Each of the 211 fentanyl-treated patients and 214 morphone-treated patients were assigned a different physical therapy to work with them following surgery. Each physical therapist completed the Physical Therapist EOC Questionnaire after each therapy session with each patient to rate the ease of patient care with the method of pain control. Overall EOC was calculated as the mean of scores on the following subscales: Time-Consuming (measuring time-efficiency) and Bothersome (measuring convenience).

For overall EOC, the percentages of patients receiving fentanyl ITS or morphine IV PCA and identified as responders were 42.0% and 28.2%, respectively (P < .001).

Patients in the fentanyl and the morphine groups rated their treatment's EOC as follows:
- Movement (97.4% vs 72.1%, respectively; P < .001);
- Confidence with Device (91.8% vs 82.4%, respectively; P < .001);
- Knowledge/Understanding of Use of the Device (71.3% vs 63.9%, respectively; P = .021).

Among the physical therapists, fentanyl and morphine were rated as follows for overall EOC: 83.9% and 56.7%, respectively (P < .001). With regard to time-efficiency, 85.9% and 60.8% of physical therapists were responders for fentanyl ITS and morphine IV PCA, respectively (P < .001). With regard to convenience, physical therapy ratings were 87.3% and 71.6%, respectively (P < .001).

"Given the therapeutic equivalence of fentanyl ITS and morphine IV PCA, findings from this EOC analysis suggest that the compact, self-contained fentanyl ITS may offer advantages over morphine IV PCA to patients and physical therapists, particularly with regard to ease of mobility," Dr. Bourne concluded.

The study was sponsored by Ortho-McNeil in Raritan, New Jersey.

[Presentation title: Total Hip Replacement and Ease of Care Using Fentanyl Iontophoretic Transdermal System (ITS)) Versus Morphine Intravenous Patient-Controlled Analgesia (IV PCA). Abstract P083]

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