Efficacy Comparison of Transdermal Fentanyl and IV Morphine PCA in Post-orthopedic Surgery Pain: A Randomized Clinical Trial
Öz
Aim: Effective postoperative pain management is crucial for early mobilization and recovery in orthopedic surgery patients. While intravenous patient-controlled analgesia (IV-PCA) with morphine is widely used, it has limitations including IV access dependency and mobility restrictions. Transdermal fentanyl (TDF) patches have emerged as an alternative due to their long-lasting analgesic effects. This study compares their efficacies in managing postoperative pain following orthopedic surgeries and evaluates patient satisfaction levels.
Material and Method: This prospective, randomized, controlled, comparative study included 40 patients aged 20-65 years undergoing orthopedic surgery under general anesthesia between July-December 2010. Patients were randomized into Group TDF (n=20) and Group IV-PCA (n=20). Postoperative pain intensity quantification was performed utilizing standardized VAS methodology, while concurrent sedation depth monitoring employed RSS parameters throughout the initial 24-hour postoperative period. Additionally, hemodynamic parameters, rescue analgesia requirements, side effects, and satisfaction levels were monitored.
Results: Post-surgical nociceptive metrics demonstrated significant temporal reduction across both cohorts (p<.001). Beyond the initial 90-minute phase, IV-PCA administration achieved superior analgesic efficacy compared to transcutaneous delivery (p<.001). Sedation parameters and adverse event profiles maintained statistical equivalence between modalities (p>.05). Patient-reported satisfaction metrics indicated significant preference for automated morphine administration protocols (p<.001).
Conclusion: Despite providing adequate initial pain relief, TDF patches demonstrated lower efficacy compared to IV-PCA with morphine in managing postoperative pain and achieving patient satisfaction following orthopedic surgery. These findings suggest the need for careful consideration when selecting postoperative pain management strategies.
Anahtar Kelimeler
Pain postoperative patient-controlled analgesia fentanyl/therapeutic use
Etik Beyan
The research protocol was approved by the Clinical Research Ethics Committee of Pamukkale University Faculty of Medicine (Reference Number: 2, Approval Date: 30.06.2010). The study was conducted in accordance with the principles outlined in the Declaration of Helsinki for research involving human participants. Written informed consent was obtained from all participants prior to their enrollment in the study.
Kaynakça
- Hall MJ, Dixon SM, Bracey M, et al. A randomized controlled trial of postoperative analgesia following total knee replacement: transdermal Fentanyl patches versus patient controlled analgesia (PCA). Eur J Orthop Surg Traumatol. 2015;25:1073-9.
- Hartrick CT, Bourne MH, Gargiulo K, et al. Fentanyl iontophoretic transdermal system for acute-pain management after orthopedic surgery: a comparative study with morphine intravenous patient-controlled analgesia. Reg Anesth Pain Med. 2006;31:546-54.
- Langford RM, Chang KY, Ding L, Abraham J. Comparison of fentanyl iontophoretic transdermal system and routine care with morphine intravenous patient-controlled analgesia in the management of early postoperative mobilisation: results from a randomised study. Br J Pain. 2016;10:198-208.
- Kaye AD, Menard BL, Ehrhardt KP, et al. Consensus Perioperative Management Best Practices for Patients on Transdermal Fentanyl Patches Undergoing Surgery. Curr Pain Headache Rep. 2019;23:50.
- Ebrahimzadeh MH, Mousavi SK, Ashraf H, et al. Transdermal fentanyl patches versus patient-controlled intravenous morphine analgesia for postoperative pain management. Iran Red Crescent Med J. 2014;16:e11502.
- Jang JS, Hwang SM, Kwon Y, et al. Is the transdermal fentanyl patch an efficient way to achieve acute postoperative pain control? A randomized controlled trial. Medicine (United States). 2018;97:e13768.
- Merivirta R, Pitkänen M, Alanen J, et al. Postoperative pain management with transdermal fentanyl after forefoot surgery: A randomized, placebo-controlled study. J Pain Res. 2015;8:39-45.
- Labmayr V, Rief M, Reinbacher P, et al. Simplified pain management including fentanyl TTS in PACU patients with hip fracture surgery to improve patients’ well-being: a double-blind randomized trial. J Perianesth Nurs. 2024;39:461-7.
- Sathitkarnmanee T, Tribuddharat S, Noiphitak K, et al. Transdermal fentanyl patch for postoperative analgesia in total knee arthroplasty: A randomized double-blind controlled trial. J Pain Res. 2014;7:449-54.
- Minville V, Lubrano V, Bounes V, et al. Postoperative analgesia after total hip arthroplasty: patient-controlled analgesia versus transdermal fentanyl patch. J Clin Anesth. 2008;20:280-3.
- Solak O, Öz G, Kokulu S, et al. The effectiveness of transdermal opioid in the management multiple rib fractures: Randomized clinical trial. Balkan Med J. 2013;30:277-81.
- Kömürcü Ş, Turhal S, Altundag K, et al. Safety and efficacy of transdermal fentanyl in patients with cancer pain: phase IV, Turkish oncology group trial. Eur J Cancer Care (Engl). 2007;16:67-73.
- Abrisham SMJ, Ghahramani R, Heiranizadeh N, et al. Reduced morphine consumption and pain severity with transdermal fentanyl patches following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2014;22:1580-4.
- Ramsay MAE, Savege TM, Simpson BRJ, Goodwin R. Controlled sedation with alphaxalone-alphadolone. Br Med J. 1974;2:656-9.
- Cooper R, Mirakhur RK, Clarke RSJ, Boules Z. Comparison of intubating conditions after administration of org 9426 (rocuronium) and suxamethonium. Br J Anaesth. 1992;69:269-73.
- Murphy GS, Brull SJ. Residual neuromuscular block: lessons unlearned. Part I: definitions, incidence, and adverse physiologic effects of residual neuromuscular block. Anesth Analg. 2010;111:120-8.
- Myles PS, Williams DL, Hendrata M, et al. Patient satisfaction after anaesthesia and surgery: results of a prospective survey of 10,811 patients. Br J Anaesth. 2000;84:6-10.
- Broome IJ, Wright BM, Bower S, Reilly CS. Postoperative analgesia with transdermal fentanyl following lower abdominal surgery. Anaesthesia. 1995;50:300-3.
- Hosseini H, Kargar S, Shiryazdi SM, et al. Fentanyl transdermal patch (Durogesic® D-TRANS) for post abdominal laparotomy analgesia: a double blind randomized study. Minerva Chir. 2015;70:401-8.
Öz
Kaynakça
- Hall MJ, Dixon SM, Bracey M, et al. A randomized controlled trial of postoperative analgesia following total knee replacement: transdermal Fentanyl patches versus patient controlled analgesia (PCA). Eur J Orthop Surg Traumatol. 2015;25:1073-9.
- Hartrick CT, Bourne MH, Gargiulo K, et al. Fentanyl iontophoretic transdermal system for acute-pain management after orthopedic surgery: a comparative study with morphine intravenous patient-controlled analgesia. Reg Anesth Pain Med. 2006;31:546-54.
- Langford RM, Chang KY, Ding L, Abraham J. Comparison of fentanyl iontophoretic transdermal system and routine care with morphine intravenous patient-controlled analgesia in the management of early postoperative mobilisation: results from a randomised study. Br J Pain. 2016;10:198-208.
- Kaye AD, Menard BL, Ehrhardt KP, et al. Consensus Perioperative Management Best Practices for Patients on Transdermal Fentanyl Patches Undergoing Surgery. Curr Pain Headache Rep. 2019;23:50.
- Ebrahimzadeh MH, Mousavi SK, Ashraf H, et al. Transdermal fentanyl patches versus patient-controlled intravenous morphine analgesia for postoperative pain management. Iran Red Crescent Med J. 2014;16:e11502.
- Jang JS, Hwang SM, Kwon Y, et al. Is the transdermal fentanyl patch an efficient way to achieve acute postoperative pain control? A randomized controlled trial. Medicine (United States). 2018;97:e13768.
- Merivirta R, Pitkänen M, Alanen J, et al. Postoperative pain management with transdermal fentanyl after forefoot surgery: A randomized, placebo-controlled study. J Pain Res. 2015;8:39-45.
- Labmayr V, Rief M, Reinbacher P, et al. Simplified pain management including fentanyl TTS in PACU patients with hip fracture surgery to improve patients’ well-being: a double-blind randomized trial. J Perianesth Nurs. 2024;39:461-7.
- Sathitkarnmanee T, Tribuddharat S, Noiphitak K, et al. Transdermal fentanyl patch for postoperative analgesia in total knee arthroplasty: A randomized double-blind controlled trial. J Pain Res. 2014;7:449-54.
- Minville V, Lubrano V, Bounes V, et al. Postoperative analgesia after total hip arthroplasty: patient-controlled analgesia versus transdermal fentanyl patch. J Clin Anesth. 2008;20:280-3.
- Solak O, Öz G, Kokulu S, et al. The effectiveness of transdermal opioid in the management multiple rib fractures: Randomized clinical trial. Balkan Med J. 2013;30:277-81.
- Kömürcü Ş, Turhal S, Altundag K, et al. Safety and efficacy of transdermal fentanyl in patients with cancer pain: phase IV, Turkish oncology group trial. Eur J Cancer Care (Engl). 2007;16:67-73.
- Abrisham SMJ, Ghahramani R, Heiranizadeh N, et al. Reduced morphine consumption and pain severity with transdermal fentanyl patches following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2014;22:1580-4.
- Ramsay MAE, Savege TM, Simpson BRJ, Goodwin R. Controlled sedation with alphaxalone-alphadolone. Br Med J. 1974;2:656-9.
- Cooper R, Mirakhur RK, Clarke RSJ, Boules Z. Comparison of intubating conditions after administration of org 9426 (rocuronium) and suxamethonium. Br J Anaesth. 1992;69:269-73.
- Murphy GS, Brull SJ. Residual neuromuscular block: lessons unlearned. Part I: definitions, incidence, and adverse physiologic effects of residual neuromuscular block. Anesth Analg. 2010;111:120-8.
- Myles PS, Williams DL, Hendrata M, et al. Patient satisfaction after anaesthesia and surgery: results of a prospective survey of 10,811 patients. Br J Anaesth. 2000;84:6-10.
- Broome IJ, Wright BM, Bower S, Reilly CS. Postoperative analgesia with transdermal fentanyl following lower abdominal surgery. Anaesthesia. 1995;50:300-3.
- Hosseini H, Kargar S, Shiryazdi SM, et al. Fentanyl transdermal patch (Durogesic® D-TRANS) for post abdominal laparotomy analgesia: a double blind randomized study. Minerva Chir. 2015;70:401-8.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Ağrı, Ortopedi |
| Bölüm | Özgün Makaleler |
| Yazarlar | |
| Yayımlanma Tarihi | 9 Mayıs 2025 |
| Gönderilme Tarihi | 6 Şubat 2025 |
| Kabul Tarihi | 12 Mart 2025 |
| Yayımlandığı Sayı | Yıl 2025 Cilt: 7 Sayı: 2 |
Chief Editors
Assoc. Prof. Zülal Öner
İzmir Bakırçay University, Department of Anatomy, İzmir, Türkiye
Assoc. Prof. Deniz Şenol
Düzce University, Department of Anatomy, Düzce, Türkiye
Editors
Assoc. Prof. Serkan Öner
İzmir Bakırçay University, Department of Radiology, İzmir, Türkiye
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