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

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

Kaynakça

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