Transdermal Fentanyl Patch as a Component of Multimodal Analgesic Regimen for Acute Postoperative Pain | Chapter 09 | New Horizons in Medicine and Medical Research Vol. 2

 Background: Acute pain in the postoperative phase affects around 80% of patients, with nearly 86 percent experiencing moderate to severe pain [1]. To reduce postoperative pain and improve results, enhanced recovery after surgery (ERAS) proposes a multimodal analgesic regimen [2]. The multimodal analgesic regimen prioritises the decrease of opioid analgesia reliance, and pain is handled at different levels using different mechanisms of action, thereby treating pain and reducing complications associated with any specific medicine. Various methods (regional anaesthesia, nerve blocks, local infiltration) and medications, including non-opiate nonsteroidal anti-inflammatory drugs, paracetamol, Cyclooxygenase2 inhibitors, NMDA receptor antagonists, gabapentins, pregabalins, and alpha 2 receptor agonists, and opioids, are incorporated into the treatment regimen as needed. After 12-24 hours of administration, the transdermal fentanyl patch provides steady-state plasma levels, and the plasma levels remain stable for the remaining 72 hours, providing effective analgesia [3].

The primary goal of this study was to evaluate pain treatment in the postoperative period using a transdermal fentanyl patch in opioid-naive patients, and the secondary goal was to evaluate any associated side effects.

Material and Methods: A total of 44 patients were randomly assigned to one of two groups. The groups were labelled as FP (Fentanyl patch) and P (Paracetamol patch) ( Placebo). The Patch was applied 10-12 hours before surgery, and the patient was monitored for pain by NRS for 72 hours after surgery (Numeric Rating Scale). All of the patients were regularly given Paracetamol and Diclofenac Sodium. Tramadol was given as a rescue analgesic if the NRS scale was more than 5. The data was analysed using the Windows stat version 9.2 of Indostat services.

Results: There was a statistically significant difference in Tramadol intake over 72 hours between patients in the FP group (19.44mg) and the P group (72.22mg). The FP group also had significantly lower Numerical Rating scale scores of 8, 16, 24, 32, 40, 48, 56, 64, and 72 hours. The FP group had the greatest difference in pain score at 24 hours. Sedation, pruritus, respiratory depression, nausea, and vomiting scores did not differ between the two groups.

Conclusion: As part of multimodal analgesia, a 25g/hr transdermal Fentanyl patch administered 10-12 hours before surgery provides good postoperative pain management after major abdominal surgery.

Author(S) Details

S. Kalyani Surya Dhana Lakshmi
Department of Anaesthesiology, AIIMS Bibinagar Hyderabad, Telangana, India.

C. N. Chandrasekhar
Department of Anaesthesiology, AIIMS Bibinagar Hyderabad, Telangana, India.

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