The Effectiveness of Transdermal Opioid in the Management Multiple Rib Fractures: Randomized Clinical Trial

Abstract

Background: The most commonly observed pathology in chest traumas is rib fracture, and the most important clinical symptom is severe pain. Aims: To investigate the effectiveness of intramuscular opioid (IMO), intravenous patient-controlled analgesia (IVPCA) and the Fentanyl transdermal therapeutic system (TTS) in the management of rib fracture pain. Study Design: Prospective randomized clinical trial. Methods: In our prospective and randomised study, we included 45 patients with a diagnosis of multiple rib fractures. There were three groups and intercostal nerve blockage (ICB) in the first day and oral paracetamol for five days was administered to each group as standard. In Group IMO (n=15), 4x40 mg pethidine HCl was administered to the patients, while in Group IVPCA (n=15) this was 5 µg/mL continuous intravenous fentanyl and was 50 µg fentanyl TTS in Group TTS (n=15). The demographics, injury data and vital signs of the patients were recorded. Pain was scored using Visual Analogue Scale (VAS). The pain during lying down (VASl) and mobilisation (VASm) was detected. Results: There were no differences between the three groups regarding age, sex, the trauma pattern, the number and distribution of costal fracture localisations, the presence of additional pathology, complications, thoracal catheter and the duration of thoracal catheter. No significant difference between the groups regarding systolic and diastolic arterial tension, number of breaths and beats in a minute was observed (p>0.05). We observed an improvement in the mean VAS score after treatment in all three groups. The mean VASl score significantly decreased after treatment in each group (p<0.05). The mean VASl and VASm scores measured on the 1st, 2nd, 3rd, 4th and 5th days were found to be higher in Group IMO than in Groups IVPCA and TTS; however, these differences were not statistically significant (p>0.05). Conclusion: In the analgesia of patients with multiple rib fractures, TTS administration with ICB showed similar effectiveness with IVPCA administration with ICB. In the management of pain due to multiple rib fractures, TTS administration is a safe, non-invasive and effective procedure. Turkish Başlık: Çok Sayılı Kot Kırıklarına Bağlı Ağrıda Transdermal Opioid Tedavisinin Etkinliği Anahtar Kelimeler: Çok sayılı kot kırığı, ağrı tedavisi, hasta kontrollü analjezi, transdermal terapötik sistem. Arkaplan: Göğüs travmalarında en sık gözlenen patoloji kot fraktürüdür. Şiddetli ağrı en önemli klinik bulgudur. Amaç: Kot fraktürüne bağlı gelişen ağrı tedavisinde inramusküler opioid (IMO), intravenöz hasta kontrollü analjezi (IVHKA) ve Fentanil transdermal terapötik sistemin (TTS) etkinliğini araştırmayı amaçladık. Çalışma Tasarımı: Prospektif ve randomize çalışmamıza multipl kot fraktürü olan 45 hastayı dahil ettik. Çalışmamızda 3 grup vardı. Tüm gruplara standart olarak birinci günde interkostal sinir blokajı (IKB) uygulandı ve beş gün boyunca oral parasetamol verildi. Yöntemler: IMO grubunda (n=15) 4x40 mg petidin HCl, IVPCA grubunda (n=15) devamlı intravenöz 5 µgr/mL fentanil ve TTS grubunda (n=15) 50 µgr fentanil TTS uygulandı. Hastaların demografik verileri, yaralanma bilgileri ve vital bulguları kaydedildi. Ağrı düzeyi Görsel Analog Skala (VAS) kullanılarak skorlandı. Yatar pozisyondaki ağrı düzeyi (VASy) ve hareket halindeki ağrı düzeyi (VASm) belirlendi. Bulgular: Üç grup arasında yaş, cinsiyet, travma şekli, kot fraktürlerinin lokalizasyonunun dağılımı, ek patoloji varlığı, komplikasyonlar, torakal kateter ve torakal kateter süresi açısından fark yoktu. Üç grup arasında sistolik ve diyastolik tansiyon, solunum sayısı ve dakikadaki nabız sayısı açısından anlamlı fark gözlenmedi (p>0,05). Üç grupta da tedavi sonrası ortalama VAS skorunda düzelme olduğunu gözledik. Ortalama VASy skoru tedavi sonrasında herbir grupta anlamlı olarak azaldı (p<0.05). 1., 2., 3., 4. ve 5. günlerde ölçülen ortalama VASy ve VASm skorları IMO grubunda IVHKA ve TTS gruplarına göre daha yüksek bulundu. Ancak bu farklar istatistiksel olarak anlamlı değildi (p>0.05). Sonuç: Multpl kot fraktürü olan hastalarda ağrı tedavisinde, TTS ile birlikte IKB uygulanması IVHKA ile birlikte IKB uygulanması ile benzer etkinlik gösterdi. Multipl kot fraktürüne bağlı gelişen ağrı tedavisinde TTS uygulaması güvenilir, invazif olmayan ve etkili bir işlemdir.

Keywords

• Multiple rib fracture, pain treatment, patient-controlled analgesia, transdermal therapeutic system

The Effectiveness of Transdermal Opioid in the Management Multiple Rib Fractures: Randomized Clinical Trial

Öz

Kaynakça

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