The relative potency of oral transmucosal fentanyl citrate compared with intravenous morphine in the treatment of moderate to severe postoperative pain
Jl. Lichtor et al., The relative potency of oral transmucosal fentanyl citrate compared with intravenous morphine in the treatment of moderate to severe postoperative pain, ANESTH ANAL, 89(3), 1999, pp. 732-738
Citations number
15
Categorie Soggetti
Aneshtesia & Intensive Care","Medical Research Diagnosis & Treatment
Pharmacokinetic studies have shown that oral transmucosal absorption of fen
tanyl is relatively rapid compared with gastrointestinal absorption, and it
results in increased bioavailability. We designed this study to establish
the relative potency of oral transmucosal fentanyl citrate (OTFC) compared
with IV morphine in 133 postoperative patients. The morning after surgery,
patients randomly received one dose of either OTFC (200 or 800 mu g) and a
placebo IV injection or IV morphine (2 or 10 mg) and an oral transmucosal p
lacebo unit. Pain intensity, pain relief, time to meaningful pain relief, a
nd time to remedication were recorded. Median time to onset of relief was a
pproximately 5 min for all groups. Over the first hour, little difference a
mong treatment groups was seen for pain intensity and pain relief. By 2 h a
fter study drug administration, 800 mu g of OTFC and 10 mg of IV morphine g
enerally produced similar analgesia, which was better than the smaller dose
s. Duration of analgesia with the larger doses (800 mu g of OTFC and 10 mg
of morphine) was similar and longer that produced by the smaller doses. The
larger doses of OTFC and morphine produced better and more sustained analg
esia than 200 mu g of OTFC or 2 mg of morphine. Implications: The relative
potency of oral transmucosal fentanyl citrate (OTFC) to IV morphine was 8-1
4:1. In this postoperative setting, OTFC produced rapid pain relief similar
to that produced by IV morphine. The larger doses of OTFC (800 mu g) and m
orphine (10 mg) produced better and more sustained analgesia than 200 mu g
of OTFC or 2 mg of morphine.