Fentanyl Patch vs Morphine
Limited evidence suggests no significant difference in patient outcomes between fentanyl patch and morphine.
Pharmacologic, Physical, and Cognitive Pain Alleviation for Musculoskeletal Extremity/Pelvis Surgery (2021)
This guideline was produced in collaboration with METRC, with funding provided by the US Department of Defense. Endorsed by: SOMOS, OTA

Rationale

One moderate quality study (Mattia 2010) compared fentanyl patch to MSO4 IV PCA. The authors concluded that the fentanyl patch and morphine IV PCA are both well tolerated and effective methods of pain control. Discontinuation rates and the incidence of adverse events were also evaluated.

Benefits/Harms of Implementation

All opioid medications are associated with similar side effects, consisting of nausea, vomiting, dizziness, and respiratory depression. Changing the route of administration from intravenous to an iontophoretic transdermal system (patch) eliminates some of the risks associated with intravenous administration and also allow for opioid administration after hospital dismissal.

Outcome Importance

In the setting of the current US opioid epidemic, the use of multimodal, non-opioid medications is the goal right now. Moving away from the routine use of opioids such as Fentanyl and Morphine has been a priority for surgeons, anesthesiologists and patients. The ability to provide opioid medications in the postoperative period without maintenance of intravenous access may be appealing as the number of ambulatory total joint arthroplasties increase.

Cost Effectiveness/Resource Utilization

There is limited evidence comparing cost of Morphine PCA to fentanyl patch, although removing the administration costs (pumps, tubing, nursing support, etc) is likely to make the fentanyl patch more cost-effective.

Acceptability

Iontophoretic transdermal systems have historically been used by physicians trained in chronic pain management. It is unlikely that orthopedic surgeons will be comfortable ordering and managing this route of opioid administration.

Feasibility

Both Fentanyl patch and Morphine PCA require significant physician oversight to prevent overdose or misuse. This makes both treatment options less feasible than multimodal oral analgesics.

Future Research

Future research should be focused on patients who may benefit from Fentanyl patch or Morphine PCA in the postoperative period such as chronic pain patients or those who have uncontrolled pain in the setting of aggressive multimodal oral analgesia.