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Introducing medicines into the human body by way of the skin is an ancient practice, and transdermal delivery has long been a standard for administering medications such as nitroglycerin and scopalamine. Phoresis, another method of transdermal drug delivery, is now being ordered for an increasing number of orthopaedic patients who suffer from inflammation, strains, or sprains. In phoretic drug delivery, enhancers such as electricity or ultrasound are used to stimulate drug absorption in the treatment area.To guide their patients to explore a variety of treatment options, orthopaedic nurses need a greater understanding of these phoretic modalities.
Pushing the crash cart to a Code Blue, a 42-year-old nurse sustained a right lateral wrist injury marked by pain and swelling. While the wrist strain was initially responsive to oral nonsteroidal antiinflammatory medications, the nurse experienced a number of exacerbations over the next year. The occupational health physician in her facility diagnosed chronic tenosynovitis and recommended rehabilitation. An occupational therapist initiated iontophoresis as part of the rehab regimen. Over a period of 2 years, a 34-year-old nurse developed increasingly persistent right hip pain. Oral nonsteroidal antiinflammatories provided adequate relief for continuation of work responsibilities until 4 months ago. With pain aggravated by lying on the affected side during sleep, the nurse experienced significant interference with rest. His physician's assistant diagnosed trochanteric bursitis, and ordered PT evaluation and treatment. The therapist began with seven phonophoresis treatments.
Persistent inflammation and pain required continued treatment for both these patients. However, more effective drug delivery methods were needed to facilitate their return to normal function. Transcutaneous drug delivery through iontophoresis or phonophoresis was chosen to enhance drug penetration to the affected areas.
Neither of these treatment methods is new. However, the growing use of transcutaneous drug delivery for musculoskeletal conditions makes it imperative that orthopaedic nurses have an understanding of these modalities.
Transdermal Drug Delivery
Introducing medicines into the human body by way of the skin is an ancient practice. Older methods include massage, inunction (rubbing oils into the skin), and moxa (a method of transcutaneous delivery that involves burning dried leaves of Asian medicinal herbs) (Li & Scudds, 1995). More recently, topical medicines have been applied to a convenient site for systemic action (e.g., scopalamine patches for motion sickness) or...