Fentanyl HCl iontophoretic transdermal system versus morphine IV-PCA for postoperative pain management: survey of healthcare provider opinion

Objective: This survey estimated differences in staff time requirements between fentanyl HCl iontophoretic transdermal system (fentanyl ITS) and intravenous patient-controlled analgesia (IV-PCA) in post-operative pain management. Research design and methods: European Delphi panels of nurses and anaesthesiologists, who had practical experience with both fentanyl ITS and IV-PCA, were provided a task list, developed from a previous clinical trial, associated with each modality. The panellists were asked to estimate time spent on each task. Estimates were calculated by multiplying the estimated patient proportion for whom the task was performed by the expected frequency of task performance, by the estimated task time. Results: Data is presented as mean minutes (standard deviation). Fentanyl ITS use was estimated to save an average of 68.7 min total staff time per patient per treatment period compared to IV-PCA 86.5 (20.3)) vs. 156.4 (55.2); respectively; p<0.001), the largest amount of savings being in the 'Setup' category (19.4 (6.7) vs. 47.8 (17.5), respectively; p<0.001), and mostly due to IV-PCA task elimination. Significant time savings were estimated using fentanyl ITS over IV- PCA in the 'Discontinuation' category (4.8 (2.4) vs. 20.6 (3.3), respectively; p<0.001). Panellists agreed that fentanyl ITS use would decrease staff assistance time required for helping patients during self- care routines and it may also decrease the patient's time to ambulation. Survey limitations included: possible recall bias due to the observational nature of the data; task list descriptions resulting in possible double-counting of data; no sensitivity analyses; and the declarative nature of the responses possibly leading to a dilution of survey findings. Conclusions: Fentanyl ITS use was estimated, by expert opinion, to require 44% less staff time than IV-PCA use.