POSTOPERATIVE ANALGESIA WITH PARENTERAL OPIOIDS - DOES CONTINUOUS DELIVERY UTILIZING A TRANSDERMAL OPIOID PREPARATION AFFECT ANALGESIC EFFICACY OR PATIENT SAFETY

Study Objectives: To compare, in patients who underwent major orthoped ic surgical procedures, the efficacy of intravenous (IV) patient-contr olled analgesia (PCA) with morphine combined with continuous administr ation of two doses of fentanyl or placebo via transdermal therapeutic system with fentanyl (TTSF) patches. Design: Randomized, double-blind placebo-controled study. Setting: University teaching hospital. Patien ts: 62 patients aged 18 to 65 years, presenting for elective orthopedi c surgery, and general anesthesia. Interventions: Patients were random ized to one of three groups: group 1 received two placebo patches; gro up 2 received a 20 cm(2) active patch delivering 50 mu g/hr of fentany l and a 30 cm(2) placebo patch; group 3 received a 30 cm(2) active pat ch delivering 75 mu g/hr of fentanyl and a 20 cm(2) placebo patch. All patches were placed approximately two hours prior to induction of gen eral anesthesia. General anesthesia was induced with thiopental, intub ation facilitated by the use of vecuronium or pancuronium, and anesthe sia was maintained with isoflurane in an oxygen/nitrous oxide mixture (O-2/N2O). Following surgery, IV morphine was provided using IV PCA wi th 1.5 mg of morphine with a 6-minute lockout and a 4-hour maximum dos age of 30 mg. Measurements and Main Results: The time and dosage of mo rphine administered was recorded. Vital signs, pain intensity at rest, level of sedation, and arterial oxygen saturation (SpO(2)) were measu red at intervals throughout the 72-hour study period and at 6 and 12 h ours following Patch removal. The presence of side effects was noted. Visual analog pain scores throughout the 72 hours of the study were no t significantly different among groups. Patients receiving active TTSF required less IV PCA morphine at all time intervals. However, total o pioid consumption was comparable among groups. The incidence of side e ffects was similar in all groups. Conclusions: There is no significant advantage to the routine use of continuous transdermal opioid deliver y in patients receiving IV PCA after major orthopedic surgery. (C) 199 7 by Elsevier Science Inc.