title: Comparison between Transdermal Buprenorphine and Transdermal Fentanyl for Postoperative Pain Relief after Major Abdominal Surgeries.
abstract: BACKGROUND
  Opioid is generally regarded as an important part of multimodal, perioperative analgesia, especially for moderate to severe pain. Amongst the various modes of delivery transdermal route has several potential benefits over oral and parentral administration. These include noninvasive dosing, better absorption and lack of first-pass metabolism. A transdermal drug delivery system provides steady and continuous drug delivery resulting in steady plasma concentration. Bolus dosing of systemic analgesic results in supra and sub therapeutic plasma resulting in toxic and sub analgesic plasma drug concentration. It also improves patient compliance.
  
  
  METHODS
  Sixty patients undergoing major abdominal surgery under GA were randomly divided in two groups (n=30). Group A received buprenorphine 10 mcg/h TDS and group B received 25 mcg/h fentanyl TDS, 6 hours prior to surgery. Patients were followed for three days for postoperative pain relief and adverse effects.
  
  
  RESULTS
  Baseline and demographic variables are comparable in both groups. The mean level of VAS was significantly lower in group B as compared to group A at Day 1, 2 and 3. The mean level of sedation score was significantly lower in Group B than Group A. Haemodynamic variables in both groups (SBP, DBP and HR), shows comparable values in both groups and no significant difference was observed. Five out of 30 (16.7%) patients in group A required single dose of rescue analgesic while 0 out of 30 patients (0.00%) in group B required rescue analgesic. This difference in rescue analgesic requirement in not quiet statistically significant (p-value 0.0522). Twenty percent patient in fentanyl group and 16.7% patients in buprenorphine group experienced some adverse effects. Nausea and vomiting were main side effects of the drugs. The incidence of nausea and vomiting were 6.7% and 10% in buprenorphine and fentanyl group respectively.
  
  
  CONCLUSIONS
  Fentanyl and buprenorphine TDS were effective and safe in controlling postoperative pain. Fentanyl is better than buprenorphine in this respect.
authors.affiliation: Assistant Professor, Department of Anaesthesiology, K.G. Medical University , U.P., India .
authors.forename: Zia
authors.initials: Z
authors.lastname: Arshad
authors.affiliation: Senior Resident, Department of Anaesthesiology, K.G. Medical University , U.P., India .
authors.forename: Ravi
authors.initials: R
authors.lastname: Prakash
authors.affiliation: Lecturer, Department of Anaesthesiology, K.G. Medical University , U.P., India .
authors.forename: Shefali
authors.initials: S
authors.lastname: Gautam
authors.affiliation: Lecturer, Department of Surgery, K.G. Medical University , U.P., India .
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Kumar
keywords: Fentanyl; Pain; Transdermal patch
references.citation: Minerva Anestesiol. 2013 Aug;79(8):871-83
references.pmid: 23558760
references.citation: J Palliat Med. 2008 Apr;11(3):492-501
references.pmid: 18363493
references.citation: Int J Clin Pract Suppl. 2003 Feb;(133):15-8; discussion 23-4
references.pmid: 12665119
references.citation: Eur J Pain. 2009 Mar;13(3):219-30
references.pmid: 18567516
references.citation: Clin Drug Investig. 2008;28(5):313-25
references.pmid: 18407717
references.citation: Contact Dermatitis. 2008 Dec;59(6):366-9
references.pmid: 19076888
references.citation: Drugs. 2011 Dec 24;71(18):2491-509
references.pmid: 22141389
references.citation: Recent Pat Drug Deliv Formul. 2013 Dec;7(3):184-205
references.pmid: 24025130
references.citation: Palliat Med. 2013 Sep;27(8):793-5
references.pmid: 23341102
references.citation: Drugs. 1997 Jan;53(1):109-38
references.pmid: 9010652
references.citation: CNS Drugs. 2012 Apr 1;26(4):367-73
references.pmid: 22369187
references.citation: Clin Ther. 2003 Jan;25(1):150-68
references.pmid: 12637117
references.citation: Eur J Pain. 2009 Aug;13(7):737-43
references.pmid: 18977159
references.citation: Clin Ther. 2009 Mar;31(3):503-13
references.pmid: 19393841
references.citation: Clin Pharmacokinet. 2000 Jan;38(1):59-89
references.pmid: 10668859