Matas Pažūsis, Kristijonas Jasaitis, Erika Keršytė, Andrius Macas, Žilvinas Endzinas
Transdermal fentanyl patch (TFP) is used for alleviation of chronic pain, while scientific evidence regarding its use for acute pain is insufficient.
Purpose. To compare the effects of pain control by non-steroidal anti-inflammatory drug (NSAID) and TFP and the restrictions in daily activities in patients following elective minor surgical interventions. Patients and methods. Prospective, randomised, casecontrolled study included patients aged ≥18 years who underwent elective cholecystectomy, gastric fundoplication or inguinal hernia repair. All randomised patients (fentanyl prescription group, FG, and control group, CG, 62 cases each) were administered dressing plasters for the first three post-operative days; the FG patients received 50mcg/h TFP under the plaster. Within the 4 post-operative days, the patients of both groups received diclofenac on demand. Post-operative pain at rest and during movement was evaluated using the Visual Analogue Scale on the 1st, 2nd, 3rd, 4th post-operative days. Daily activities using the Functional Activity Score were scored as 0 – no limitations, 1 – some limitations, 2 – severe limitations. Results. Pain both at rest and during movement on the first three post-operative days was lower in the FG; CG patients received 5 times more doses of diclofenac on demand on the 1st day after the surgery, with the higher need of NSAID during the next two days (p<0.05). The total number of NSAID doses per patient administered on demand was 3.11±0.59 in the CG and 0.73±0.16 in the FG (p<0.05). The influence of pain on daily activities on the 2nd post-operative day was scored as 0 by 92% patients and as 1 by 8% patients of the FG, versus 60% and 40% patients of the CG (p<0.05).
Conclusion. Patients with TFP experienced significantly more effective pain control leading to less restricted daily activities and used less doses of NSAID within the first few post-operative days.
Plain Language Summary. Could a single long-lasting dose of transdermal fentanyl patch serve as an alternative to uncontrolled consumption of non-steroid anti-inflammatory drugs when dealing with early post-operative pain in patients following a hospital discharge after an elective minor surgery? Our conclusion suggests that the answer is “yes”, if the riskbenefits balance is evaluated.
Keyword(s): analgesia, enhanced recovery, opioids, transdermal application, surgery, NSAID.