Postoperative analgesia after total hip arthroplasty: patient-controlled analgesia versus transdermal fentanyl patch.
OBJECTIVE
To determine whether a new transdermal fentanyl patch (TFP) is a good choice for the postoperative pain management of patients undergoing primary total hip arthroplasty compared with patient-controlled analgesia (PCA).


METHODS
Randomized, prospective study.


METHODS
University hospital.


METHODS
30 patients undergoing primary total hip arthroplasty.


METHODS
Patients received either a TFP (group T; Duragesic 50 microg/h, matrix fentanyl patch, Janssen-Cilag) applied approximately 10 hours before induction of general anesthesia and PCA programmed in the postanesthesia care unit (PACU), or PCA programmed in the PACU (group P).


METHODS
Intraoperative sufentanil and additional postoperative morphine administration were recorded, as well as visual analog scores and routine vital signs at predetermined intervals during the first 48 hours.


RESULTS
Morphine consumption on arrival in the PACU was 3.5+/-3 mg in group T versus 13+/-5 mg in group P (P<0.0001). Visual analog scores on arrival in the PACU were 37+/-22 mm in group T versus 73+/-13 mm in group P (P<0.0001). Cumulative morphine consumption at the 24th hour was 43+/-16 mg in group P and 4+/-3 mg in group T (P<0.0001). Cumulative morphine consumption at the 48th hour was 54+/-26 mg in group P and 5+/-4 mg in group T (P<0.0001). Intraoperative sufentanil consumption was 38+/-15 microg in group T versus 30+/-5 microg in group P (not significant). The sedation score was 0 in both groups during the first 48 postoperative hours.


CONCLUSIONS
Preoperative TFP application decreases pain scores and morphine consumption in the PACU and appears to have prolonged effects spanning the first 48 postoperative hours.
Minville
Vincent
V
Department of Anesthesiology and Intensive Care, GRCB 48, Toulouse University Hospital, University Paul Sabatier, 31403 Toulouse, France. vincentminville@yahoo.fr
Lubrano
Vincent
V
Bounes
Vincent
V
Pianezza
Antoine
A
Rabinowitz
Anna
A
Gris
Claude
C
Samii
Kamran
K
Fourcade
Olivier
O
D000279:Administration, Cutaneous; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D009020:Morphine; D005283:Fentanyl