Patch versus pump: Evaluating efficacy, satisfaction level and safety of transdermal fentanyl patch versus intravenous morphine with PCA pump for acute postoperative pain in orthopedic surgery

Abstract

Background & objective: Transdermal Fentanyl Patches (TFP) are commonly used in chronic cancer pain management. TFP offer a sustained delivery of fentanyl, due to its high lipid solubility for efficient transdermal administration. This non-invasive analgesic method is particularly advantageous for severe postoperative pain, delivering fentanyl consistently and matching morphine's effectiveness while minimizing side effects. This study was conducted to compare the effectiveness, patient satisfaction and safety of TFP versus Patient-Controlled Analgesia (PCA) IV morphine for managing acute postoperative pain in orthopedic surgery.

Methodology: This retrospective study compares the effectiveness, satisfaction and safety of TFP versus intravenous (IV) Patient-Controlled Analgesia (PCA) morphine for managing acute postoperative pain in orthopedic surgery. Data from 114 patients who underwent orthopedic surgery at Hospital Universiti Sains Malaysia (HUSM), were analysed, with 51 receiving TFP and 63 receiving PCA morphine. Primary outcomes included mean pain scores and patient satisfaction, while the incidence of side effects e.g., nausea, vomiting, respiratory depression, itchiness, and hypotension, served as a secondary outcome.

Results: TFP demonstrated equivalent analgesic efficacy to PCA morphine. A mixed-design repeated-measures ANOVA (Greenhouse-Geisser test) indicated no significant difference in mean pain scores between TFP and PCA morphine (P = 0.364, P > 0.05). Patient satisfaction rates were similarly high, with 96% satisfaction reported for TFP. Importantly, TFP exhibited fewer side effects, observed in 6 out of 51 patients, compared to PCA morphine, which caused side effects in 12 out of 63 patients, including one case of respiratory depression.

Conclusion: TFP offers comparable efficacy and patient satisfaction in acute pain management following orthopedic surgery, amd enhanced safety with fewer reported side effects compared to PCA morphine. High patient satisfaction rates further support TFP as a viable alternative in postoperative pain management.

Abbreviations: NRS: Numerical Rating Scale, PCA: Patient-Controlled Analgesia, TFP: Transdermal Fentanyl Patches, TKR: total knee replacement.

Keywords: fentanyl; morphine; analgesia; efficacy; satisfaction; safety

Citation: Hehsan MR, Saufian IS, Ismet S, Zainy RHM, Shamsul Kamalrujan Hassan SK, Ibrahim K. Patch versus pump: Evaluating efficacy, satisfaction level and safety of transdermal fentanyl patch versus intravenous morphine with PCA pump for acute postoperative pain in orthopedic surgery. Anaesth. pain intensive care 2025;29(4):349-55. DOI: 10.35975/apic.v29i4.2493

Received: May 31, 2024; Revised: May 26, 2025; Accepted: June 01, 2025