Friday, August 18, 2006

Pain Relief & Iontophoresis

I get jazzed when I see new ideas that get implemented in innovative ways. Years ago, the idea of transdermal admininstration of medications was a new approach; it became widely used with estrogen patches and the like, along with fentanyl patches for pain management.

Some smart guys decided that if fentanyl patches worked, why not use the same technology with a patient-controlled delivery system --- sort of a fentanyl patch with an on-demand component. We have had for many years patient controlled IV narcotic delivery systems (PCAs), and a transdermal delivery system would theoretically be similar. The FDA has approved the first such device, the Ionsys:

IONSYS is the first and only product to incorporate the proprietary E-TRANS® iontophoretic transdermal drug delivery system developed by ALZA. E-TRANS utilizes iontophoresis - a process in which a low-intensity electric field, which is generally imperceptible to the patient, is used to rapidly transport fentanyl across the skin and into the circulatory system of the body. IONSYS securely adheres to the upper outer arm or chest, and provides patients an on-demand dose of fentanyl.
The idea is to use this once patients have been titrated to their appropriate level of analgesia, and replace it every 24 hours (or whe 80 doses have been delivered). There is a "lockout" feature that prevents administration of more than one dose every 10 minutes.

Cool! No needles, and each unit is self-contained and disposable. I'm not a nurse, so I am not sure how much easier this little gizmo would be to use than PCA pumps, but I suspect it would alleviate at least a few hassles. My only concern is that there is no method of adjusting the dose -- some patients, particularly the postop LOL, may need a smaller dose than the unit is designed to deliver. Obviously, these are to be used only in the hospital setting; if the same technology was to be applied with much lower doses, there could theoretically be a role in the outpatient setting (postop inguinal hernia repair, for example), but a whole lot of safety testing would have to be undertaken first.


Smart folks, figuring out better ways to do things; ain't America great? Any day now, I fully expect one of you smart people out there to outfit me and all the staff at my hospital with a spanking new tricorder --- just like Dr. McCoy --- and all of our diagnostic dilemmas will disappear!