Comparison of postoperative pain management using two patient-controlled analgesia methods: nursing perspective.

Title. Comparison of postoperative pain management using two patient-controlled analgesia methods: nursing perspective. Aim.  To compare the effect of fentanyl iontophoretic transdermal system and morphine intravenous patient-controlled analgesia on the time-efficiency and convenience of postoperative patient care. Background.  Intravenous patient-controlled analgesia with morphine is effectively used to manage postoperative pain; however, it takes time to set up and administer. Methods.  Nurses evaluated patient-care tasks with fentanyl iontophoretic transdermal system and/or morphine intravenous patient-controlled analgesia in two phase IIIb studies (n = 1305) using a nurse ease-of-care questionnaire. A responder for time-efficiency and convenience responded with one of the top three positive choices on all items; for satisfaction, a responder chose one of the top two positive choices on both items. Data were collected between March 2004 and April 2005. Findings.  In both studies, greater proportions of nurses were responders for fentanyl iontophoretic transdermal system than for morphine intravenous patient-controlled analgesia, respectively, for time-efficiency [total hip replacement surgery, 80·9% (250/309) vs. 57·7% (172/298), P < 0·001; abdominal/pelvic surgery, 84·8% (162/191) vs. 57·7% (113/196), P < 0·001], convenience [total hip replacement surgery, 85·5% (271/317) vs. 64·1% (191/298), P < 0·001; abdominal/pelvic surgery, 89·2% (166/186) vs. 62·8% (123/196), P < 0·001], and satisfaction [total hip replacement surgery, 66·6% (247/371) vs. 33·3% (108/324), P < 0·001; abdominal/pelvic surgery, 67·4% (155/230) vs. 38·2% (84/220), P < 0·001]. Higher proportions of nurses favoured fentanyl iontophoretic transdermal system than morphine intravenous patient-controlled analgesia in both studies (P < 0·001). Conclusion.  The fentanyl iontophoretic transdermal system appears to be simpler, easier to use, and more satisfactory for nurses than morphine intravenous patient-controlled analgesia.