Clinical Research On Transdermal Fentanyl Used For Postoperative Acute Pain Management

Object To research the feasibility, efficacy and method of transdermal fentanyl(TDF) in the treatment of postoperative pain.Method Sixty women were divided into three groups: (1)Group T (n=20, epiduralanesthesia), abdominal hysterectomy, applied only TDF 5 mg for postoperative analgesia. (2)Group TM (n=20, epidural anesthesia) besides applying TDF 5 mg, morphine 1.5-2 mg were injected into epidural space immediately after finishing operation. (3)Group TG (n=20, general anesthesia), breast cancer resection, applied only TDF 5 mg for postoperative analgesia. The following items were investigated. (1)The changes of plasma β-endorphin (β-EP), serum prolactin (PRL) and cortisol; (2)Postoperative analgesia efficacy; (3)Influences on respiration and circulation; (4)Adverse reactions.Result (1)VAS pain scores were significantly higher in all three groups at rest andwith movement at 12 hr after the application of the patches. VAS pain scores were higher in group T at 12 and 24 hr after patch application than other time (P<0.01), and gradually down at 24hr after patch application; In the intergroup comparison, VAS pain scores were significantly higher in group T in comparing with group TMand TG. (2)The respiratory rate had no significant difference in group T. In group TM, it was significantly lower than at Ohr (P<0.05) between 12 and 24 hr after patch application. The respiratory rate between 24 and 72 hr after patch application was significantly higher than at Ohr (P<0.05) in group TG. (3)During the 72-hour study, SpO2 was>90% in all three groups when oxygen supplementation was provided. SpO2 was significantly lower when oxygen supplementation was discontinued in group T at 24, 36, 48 and 60 hr (P< 0.01 or P< 0.05), in group TM at 12, 24, 36, 48, 60 and 72 hr (P< 0.01 or P< 0.05) and in group TG at 12, 24 and 36 hr (P<0.05) compared with at 0 hr. (4)β -EP, PRL and cortisol concentrations were significantly higher in group T at 24 hr after patch application (P<0.01 or P<0.05).β-EP was significantly lower (P<0.05) in group TM at 24 hr after patch application, PRL and cortisol had no significant difference (P>0.05). However, β-EP had no significant difference in group TG (P>0.05), PRL and cortisol were significantly higher (P<0.01 or P<0.05). In the intergroup comparison, PRL was significantly (P<0.05) higher in group TG than in group T and group TM preoperatively.β -EP, PRL and cortisol were significantly higher (P<0.01 or P<0.05) in group T and group TG than in group TM postoperatively. (5)There was no significant difference in the incidence of adverse effects (nausea, vomiting, pruritus, erythema and lethargy; P>0.05) in all three groups.Conclusion (1)Breast cancer resection can apply TDF 5mg for postoperativeanalgesia alone. It can control the stress, its analgesia effect was good and safe; (2)If TDF 5mg is used for hysterectomy postoperative analgesia alone, its analgesia effect wasn't good at first 24hr. (3)If hysterectomy analgesia combines with morphine injected into epidural space. Its analgesia effect was good and it can control the stress status. But more respiratory depression may occur.