Effective pain relief is an essential component of a patient’s
peri-operative care package. Good analgesia has been shown to reduce the
incidence of cardiovascular, respiratory and thrombo-embolic complications
following surgery. Satisfactory analgesia facilitates early patient ambulation
following surgery, which may reduce in-patient stay. Patient-controlled
analgesia (PCA) systems are a well established standard therapy for acute
post-operative pain; however some practical limitations limit their clinical
utility. The fentanyl inotophoretic transdermal system (ITS) is a novel
self-contained needle-free PCA device, which delivers boluses of fentanyl
transdermally. This system has been shown to provide analgesia equivalent to
conventional PCA modalities, with unique design features that may confer
advantages to patients and staff, including facilitating patient mobilization in
the post-operative phase. This review will discuss the technology of
iontophoretic systems, the pharmacology of transdermal fentanyl delivery, and
some practical implications of the fentanyl ITS.