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Transdermal fentanyl patch for postoperative analgesia in total knee arthroplasty: a randomized double-blind controlled trial.

Sathitkarnmanee T, Tribuddharat S, Noiphitak K, Theerapongpakdee S, Pongjanyakul S, Huntula Y, Thananun M - J Pain Res (2014)

Bottom Line: Ambulation and nausea/vomiting scores were statistically greater, but not clinically significant in the TFP group.Sedation scores were low and not statistically significantly different between groups.TFP (50 μg/hour) applied 10-12 hours before surgery can effectively and safely decrease morphine consumption and pain scores during the first 48 hours after TKA surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen.

ABSTRACT

Purpose: To assess the efficacy of a transdermal fentanyl patch (TFP) (50 μg/hour) applied 10-12 hours before surgery versus placebo for postoperative pain control of total knee arthroplasty (TKA).

Materials and methods: We enrolled 40 patients undergoing elective TKA under spinal anesthesia using isobaric or hyperbaric bupivacaine. Subjects were randomized to receive a TFP (Duragesic(®) 50 μg/hour) or placebo patch applied with a self-adhesive to the anterior chest wall 10-12 hours before spinal anesthesia. Every patient was given patient-controlled morphine for postoperative pain control. Patients were evaluated every 4 hours until 48 hours.

Results: Morphine consumption at 24 and 48 hours in the TFP group versus the placebo group was 15.40±12.65 and 24.90±20.11 mg versus 33.60±19.06 and 57.80±12.65 mg (P≤0.001). Numeric rating scale scores at rest and during movement over 48 hours were lower in the TFP group. Ambulation and nausea/vomiting scores were statistically greater, but not clinically significant in the TFP group. Sedation scores were low and not statistically significantly different between groups. There was no severe respiratory depression.

Conclusion: TFP (50 μg/hour) applied 10-12 hours before surgery can effectively and safely decrease morphine consumption and pain scores during the first 48 hours after TKA surgery.

No MeSH data available.


Related in: MedlinePlus

Flowchart for patient recruitment, randomization, and follow-up.Abbreviation: TFP, transdermal fentanyl patch.
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f1-jpr-7-449: Flowchart for patient recruitment, randomization, and follow-up.Abbreviation: TFP, transdermal fentanyl patch.

Mentions: The patients, admitted 1 day prior to the surgery, were then allocated to two groups: group T received a single TFP (Duragesic® 50 μg/hour matrix fentanyl patch; Janssen Pharmaceutica, Beerse, Belgium) affixed to the anterior chest wall 10–12 hours before surgery by the preoperative-visit resident; and group P received a placebo patch in the same manner. Spinal anesthesia was given using either hyperbaric or isobaric bupivacaine at a standard dosage. All of the patients received standard intraoperative monitoring and care. After surgery, they were transferred to the postanesthetic care unit. Time of arrival at the unit represented time 0. The severity of pain was determined using a numeric rating scale (NRS). PCA was started after the NRS had fallen to ≤3 in response to intravenous morphine supplementation (at 2 mg/5 minute intervals). The PCA device was set at 1 mg of morphine with a 5-minute lockout and a 1-hour limit of 8 mg. Every 4 hours until 48 hours, we recorded morphine consumption, blood pressure, respiratory rate, NRS score at rest and when moving, ambulation, sedation, and nausea/vomiting (N/V) score. The TFP was removed at 48 hours (Figure 1).


Transdermal fentanyl patch for postoperative analgesia in total knee arthroplasty: a randomized double-blind controlled trial.

Sathitkarnmanee T, Tribuddharat S, Noiphitak K, Theerapongpakdee S, Pongjanyakul S, Huntula Y, Thananun M - J Pain Res (2014)

Flowchart for patient recruitment, randomization, and follow-up.Abbreviation: TFP, transdermal fentanyl patch.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4128837&req=5

f1-jpr-7-449: Flowchart for patient recruitment, randomization, and follow-up.Abbreviation: TFP, transdermal fentanyl patch.
Mentions: The patients, admitted 1 day prior to the surgery, were then allocated to two groups: group T received a single TFP (Duragesic® 50 μg/hour matrix fentanyl patch; Janssen Pharmaceutica, Beerse, Belgium) affixed to the anterior chest wall 10–12 hours before surgery by the preoperative-visit resident; and group P received a placebo patch in the same manner. Spinal anesthesia was given using either hyperbaric or isobaric bupivacaine at a standard dosage. All of the patients received standard intraoperative monitoring and care. After surgery, they were transferred to the postanesthetic care unit. Time of arrival at the unit represented time 0. The severity of pain was determined using a numeric rating scale (NRS). PCA was started after the NRS had fallen to ≤3 in response to intravenous morphine supplementation (at 2 mg/5 minute intervals). The PCA device was set at 1 mg of morphine with a 5-minute lockout and a 1-hour limit of 8 mg. Every 4 hours until 48 hours, we recorded morphine consumption, blood pressure, respiratory rate, NRS score at rest and when moving, ambulation, sedation, and nausea/vomiting (N/V) score. The TFP was removed at 48 hours (Figure 1).

Bottom Line: Ambulation and nausea/vomiting scores were statistically greater, but not clinically significant in the TFP group.Sedation scores were low and not statistically significantly different between groups.TFP (50 μg/hour) applied 10-12 hours before surgery can effectively and safely decrease morphine consumption and pain scores during the first 48 hours after TKA surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen.

ABSTRACT

Purpose: To assess the efficacy of a transdermal fentanyl patch (TFP) (50 μg/hour) applied 10-12 hours before surgery versus placebo for postoperative pain control of total knee arthroplasty (TKA).

Materials and methods: We enrolled 40 patients undergoing elective TKA under spinal anesthesia using isobaric or hyperbaric bupivacaine. Subjects were randomized to receive a TFP (Duragesic(®) 50 μg/hour) or placebo patch applied with a self-adhesive to the anterior chest wall 10-12 hours before spinal anesthesia. Every patient was given patient-controlled morphine for postoperative pain control. Patients were evaluated every 4 hours until 48 hours.

Results: Morphine consumption at 24 and 48 hours in the TFP group versus the placebo group was 15.40±12.65 and 24.90±20.11 mg versus 33.60±19.06 and 57.80±12.65 mg (P≤0.001). Numeric rating scale scores at rest and during movement over 48 hours were lower in the TFP group. Ambulation and nausea/vomiting scores were statistically greater, but not clinically significant in the TFP group. Sedation scores were low and not statistically significantly different between groups. There was no severe respiratory depression.

Conclusion: TFP (50 μg/hour) applied 10-12 hours before surgery can effectively and safely decrease morphine consumption and pain scores during the first 48 hours after TKA surgery.

No MeSH data available.


Related in: MedlinePlus