title: Postoperative pain management with transdermal fentanyl after forefoot surgery: a randomized, placebo-controlled study.
abstract: BACKGROUND
  Quality of life is decreased in patients with hallux valgus deformity, mainly because of pain. Significant improvement is usually achieved by surgery. However, postoperative pain can be moderate to severe for 2-3 days. The aim of the present study was to evaluate the use of transdermal fentanyl for postoperative pain management after forefoot surgery.
  
  
  METHODS
  Sixty patients undergoing hallux valgus or hallux rigidus surgery were allocated to receive a patch delivering either fentanyl 12 μg/hour or placebo for postoperative pain. The consumption of rescue opioid oxycodone, the primary outcome measure, was evaluated daily until the fourth postoperative day. Total consumption of oxycodone during the study period was also assessed. Pain scores and possible adverse effects were evaluated every 6 hours during the first 24 hours and on the fourth postoperative day.
  
  
  RESULTS
  The use of rescue opioid was low in both groups, the median (range) consumption of oxycodone being 10 (0-50) mg on the day of surgery (no difference between the groups, P=0.31) and 0 (0-35) mg thereafter. The total combined consumption was 10 (0-105) mg in the fentanyl group and 20 (0-70) mg in the placebo group (P=0.23). There were no statistically significant differences in pain scores or adverse effects between the groups.
  
  
  CONCLUSIONS
  As a part of multimodal analgesia with ibuprofen and acetaminophen, a patch delivering fentanyl 12 μg/hour did not significantly decrease the consumption of rescue opioid or pain scores after forefoot surgery.
authors: Department of Anaesthesiology, Intensive Care, Emergency Care and Pain Medicine of Turku University Hospital and University of Turku, Turku.
authors: Riika
authors: R
authors: Merivirta
authors: Department of Anaesthesia, Hospital Orton, Invalid Foundation, Helsinki, Finland.
authors: Mikko
authors: M
authors: Pitkänen
authors: Terveystalo Clinic Hospital, Helsinki, Finland.
authors: Jouko
authors: J
authors: Alanen
authors: Department of Anaesthesiology, Intensive Care, Emergency Care and Pain Medicine of Turku University Hospital and University of Turku, Turku.
authors: Elina
authors: E
authors: Haapoja
authors: Department of Biostatistics, University of Turku, Turku, Finland.
authors: Mari
authors: M
authors: Koivisto
authors: Department of Anaesthesiology, Intensive Care, Emergency Care and Pain Medicine of Turku University Hospital and University of Turku, Turku.
authors: Kristiina
authors: K
authors: Kuusniemi
keywords: forefoot surgery; hallux rigidus; hallux valgus; multimodal analgesia; pain management; transdermal fentanyl
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