Clinical Research On Fentanyl Transdermal Patch For Reducing Vascular Crisis After Digital Replantation

Objective To explore the effects of the preemptive analgesia of fentanyl transdermal patch for prevention and reduction of vascular crisis after digital replantationMethods From October 2011 to September 2012,100 cases of index and middle finger and thumb replantation which are innervated by the median nerve and the radial nerve in our hospital were divided into two groups according to chronological order: in the control group,conventional anti-inflammatory,anticoagulation and antispasmodic treatment was used in 50 cases;analgesic drugs were administered to the patients when postoperative pain occurred and the VAS pain score was more than 3 following the effects of the anaesthetic;in experimental group,fentanyl transdermal patch was administered to 50 cases after operation when the patients were still under the anesthetic.The patch was placed on the wrist surface projection of the median nerve,which was named preemptive analgesia.The incidences of vascular crisis between two groups were observed and compared.Results In control group,postoperative VAS pain score was from 0 to 3 in 5 cases,from 4 to 6 in 28 cases,and 7 to 10 in 17 cases.Vascular crisis occurred in 15 cases with the ratio of 30% and there were 9 men and 6 women.Analgesic drugs were used when the score was more than 3,resulting in reducing the score up to less than 3;in experiment group,postoperative VAS pain score was from 0 to 3 in 41 cases,and from 4 to 6 in 9 cases.Vascular crisis occurred in 6 cases with the ratio of 12% and there were 3 men and 3 women.Analgesic drugs were administered to the patients whose score was from 4 to 6,resulting in reducing the score up to less than 3.The ratio of vascular crisis in the experimental group was lower than in the control group,and there was a significant differences between two groups(P=0.027<0.05).Vascular crisis in 12 male cases,and 9 female cases,and there was no significant differences between two groups(P=0.396>0.05)Conclusions The ratio of vascular crisis of the patients who received fentanyl transdermal patch as preemptive analgesia after digital replantation was lower than that of the patients who did receive the patch.There was a significant differences between two groups(P=0.027<0.05).The preemptive analgesia of fentanyl transdermal patch can prevent and reduce the vascular crisis after digital replantation.