Efficacy Comparison of Transdermal Fentanyl and IV Morphine PCA in Post-orthopedic Surgery Pain: A Randomized Clinical Trial

Year 2025, Volume: 7 Issue: 2, 441 - 449, 09.05.2025

Seher İlhan , Habib Atalay

https://doi.org/10.37990/medr.1634371

Abstract

Aim: Effective postoperative pain management is crucial for early mobilization and recovery in orthopedic surgery patients. While intravenous patient-controlled analgesia (IV-PCA) with morphine is widely used, it has limitations including IV access dependency and mobility restrictions. Transdermal fentanyl (TDF) patches have emerged as an alternative due to their long-lasting analgesic effects. This study compares their efficacies in managing postoperative pain following orthopedic surgeries and evaluates patient satisfaction levels.
Material and Method: This prospective, randomized, controlled, comparative study included 40 patients aged 20-65 years undergoing orthopedic surgery under general anesthesia between July-December 2010. Patients were randomized into Group TDF (n=20) and Group IV-PCA (n=20). Postoperative pain intensity quantification was performed utilizing standardized VAS methodology, while concurrent sedation depth monitoring employed RSS parameters throughout the initial 24-hour postoperative period. Additionally, hemodynamic parameters, rescue analgesia requirements, side effects, and satisfaction levels were monitored.
Results: Post-surgical nociceptive metrics demonstrated significant temporal reduction across both cohorts (p<.001). Beyond the initial 90-minute phase, IV-PCA administration achieved superior analgesic efficacy compared to transcutaneous delivery (p<.001). Sedation parameters and adverse event profiles maintained statistical equivalence between modalities (p>.05). Patient-reported satisfaction metrics indicated significant preference for automated morphine administration protocols (p<.001).
Conclusion: Despite providing adequate initial pain relief, TDF patches demonstrated lower efficacy compared to IV-PCA with morphine in managing postoperative pain and achieving patient satisfaction following orthopedic surgery. These findings suggest the need for careful consideration when selecting postoperative pain management strategies.

Keywords

Pain , postoperative , patient-controlled analgesia , fentanyl/therapeutic use

Ethical Statement

The research protocol was approved by the Clinical Research Ethics Committee of Pamukkale University Faculty of Medicine (Reference Number: 2, Approval Date: 30.06.2010). The study was conducted in accordance with the principles outlined in the Declaration of Helsinki for research involving human participants. Written informed consent was obtained from all participants prior to their enrollment in the study.

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