Six RCTs were included in the review (n=3,270). Jadad scores were 2 (one RCT) or 3 (five RCTs) out of a possible 5 points. OPVS scores were 9, 10 or 12 points (two RCTs each) out of a possible 16 points.
Fentanyl ITS compared with placebo (two RCTs, n=673): In the intervention group there were significantly lower rates of dropout due to inadequate analgesia (OR 0.32, 95% CI 0.23 to 0.45; two RCTs) and significantly lower pain scores (WMD -17.47mm, 95% CI -21.64 to -13.30; two RCTs).
Fentanyl ITS compared with morphine PCA (two RCTs, n=2,597): There was no statistically significant difference between the groups in pain relief or overall dropout rates. In the fentanyl ITS group the dropout rate due to inadequate analgesia was significantly higher (OR 2.01, 95% CI 1.47 to 2.74; four RCTs), but pain intensity scores at 24 hours were significantly lower (WMD -1.74mm, 95% CI -3.37, -0.12; four RCTs) and dropout rates due to adverse events were significantly lower (OR 0.66, 95% CI 0.46, 0.94; four RCTs).
Fixed-effect models were used throughout. Results for specific adverse events were reported in the review.