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

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 arthoplasty. Interventions: Patients received either a TFP (group T; Duragesic 50 mu g/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). Intraciperative sufentanil consumption was 38 +/- 15 mu g in group T versus 30 +/- 5 mu g 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, (C) 2008 Elsevier Inc. All rights reserved.