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Postoperative analgesia after total hip arthroplasty: patient-controlled analgesia versus transdermal fentanyl patch.

Abstract : STUDY 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). DESIGN: Randomized, prospective study. SETTING: University hospital. PATIENTS: 30 patients undergoing primary total hip arthroplasty. INTERVENTIONS: 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). MEASUREMENTS: 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. MAIN 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.
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https://www.hal.inserm.fr/inserm-00409216
Contributor : Marie Francoise Simon <>
Submitted on : Thursday, August 6, 2009 - 3:02:43 PM
Last modification on : Sunday, October 25, 2020 - 7:07:40 AM

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Vincent Minville, Vincent Lubrano, Vincent Bounes, Antoine Pianezza, Anna Rabinowitz, et al.. Postoperative analgesia after total hip arthroplasty: patient-controlled analgesia versus transdermal fentanyl patch.. Journal of Clinical Anesthesia, Elsevier, 2008, 20 (4), pp.280-3. ⟨10.1016/j.jclinane.2007.12.013⟩. ⟨inserm-00409216⟩

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