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Published in: Archives of Orthopaedic and Trauma Surgery 9/2015

01-09-2015 | Knee Arthroplasty

Transdermal fentanyl patch improves post-operative pain relief and promotes early functional recovery in patients undergoing primary total knee arthroplasty: a prospective, randomised, controlled trial

Authors: Shigemi Matsumoto, Kazu Matsumoto, Hiroki Iida

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 9/2015

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Abstract

Introduction

The aim of the present study was to evaluate the efficacy and safety of a 12.5 μg/h transdermal fentanyl patch (TFP).

Materials and Methods

Fifty-two patients scheduled for primary total knee arthroplasty (TKA) were recruited in the study. They were randomly divided into two groups: patients provided with a transdermal fentanyl patch (Group TFP) and those provided with non-steroid anti-inflammatory drugs (Group NSAID). The patients in the TFP and NSAID groups had mean ages of 70.1 years (range 36–86 years) and 73.5 years (range 32–86 years), respectively. Post-operative pain intensity was measured using the visual analogue scale both at rest and during movement (mVAS). We also evaluated lower leg functional recovery and adverse events.

Results

The mean mVAS scores were not different between the two groups on post-operative day 4, but were significantly smaller in the TFP group than in the NSAID group on post-operative days 7 (p = 0.0026) and 14 (p = 0.007). Muscle strength recovered faster in the TFP group than in the NSAID group, the percentage of pre-operative strength being significantly greater in the former than in the latter on post-operative days 7 (p = 0.027) and 14 (p = 0.047). Furthermore, there were no remarkable adverse events in patients using TFP.

Conclusion

We conclude that a 12.5 μg/h TFP can improve post-operative pain relief and promotes early functional recovery following total knee arthroplasty.
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Literature
1.
go back to reference Hawker G, Wright J, Coyte P et al (1998) Health-related quality of life after knee replacement. J Bone Joint Surg Am 80(2):163–173PubMed Hawker G, Wright J, Coyte P et al (1998) Health-related quality of life after knee replacement. J Bone Joint Surg Am 80(2):163–173PubMed
2.
go back to reference Meding JB, Meding LK, Ritter MA et al (2012) Pain relief and functional improvement remain 20 years after knee arthroplasty. Clin Orthop Relat Res 470(1):144–149PubMedCentralCrossRefPubMed Meding JB, Meding LK, Ritter MA et al (2012) Pain relief and functional improvement remain 20 years after knee arthroplasty. Clin Orthop Relat Res 470(1):144–149PubMedCentralCrossRefPubMed
3.
go back to reference Norman-Taylor FH, Palmer CR, Villar RN (1996) Quality-of-life improvement compared after hip and knee replacement. J Bone Joint Surg Br 78(1):74–77PubMed Norman-Taylor FH, Palmer CR, Villar RN (1996) Quality-of-life improvement compared after hip and knee replacement. J Bone Joint Surg Br 78(1):74–77PubMed
4.
go back to reference Chelly JE, Ben-David B, Williams BA et al (2003) Anesthesia and postoperative analgesia: outcomes following orthopedic surgery. Orthopedics. 26(8 Suppl):s865–s871 (Review) PubMed Chelly JE, Ben-David B, Williams BA et al (2003) Anesthesia and postoperative analgesia: outcomes following orthopedic surgery. Orthopedics. 26(8 Suppl):s865–s871 (Review) PubMed
5.
go back to reference Cheville A, Chen A, Oster G et al (2001) A randomized trial of controlled-release oxycodone during inpatient rehabilitation following unilateral total knee arthroplasty. J Bone Joint Surg Am 83-A(4):572–576PubMed Cheville A, Chen A, Oster G et al (2001) A randomized trial of controlled-release oxycodone during inpatient rehabilitation following unilateral total knee arthroplasty. J Bone Joint Surg Am 83-A(4):572–576PubMed
6.
go back to reference Modig J, Borg T, Karlström G et al (1983) Thromboembolism after total hip replacement: role of epidural and general anesthesia. Anesth Analg 62(2):174–180CrossRefPubMed Modig J, Borg T, Karlström G et al (1983) Thromboembolism after total hip replacement: role of epidural and general anesthesia. Anesth Analg 62(2):174–180CrossRefPubMed
7.
go back to reference Rodgers A, Walker N, Schug S et al (2000) Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ 321(7275):1493PubMedCentralCrossRefPubMed Rodgers A, Walker N, Schug S et al (2000) Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ 321(7275):1493PubMedCentralCrossRefPubMed
8.
go back to reference Singelyn FJ, Deyaert M, Joris D et al (1998) Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous three-in-one block on postoperative pain and knee rehabilitation after unilateral total knee arthroplasty. Anesth Analg 87(1):88–92PubMed Singelyn FJ, Deyaert M, Joris D et al (1998) Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous three-in-one block on postoperative pain and knee rehabilitation after unilateral total knee arthroplasty. Anesth Analg 87(1):88–92PubMed
9.
go back to reference Harden RN, Bruehl S, Stanos S et al (2003) Prospective examination of pain-related and psychological predictors of CRPS-like phenomena following total knee arthroplasty: a preliminary study. Pain 106(3):393–400CrossRefPubMed Harden RN, Bruehl S, Stanos S et al (2003) Prospective examination of pain-related and psychological predictors of CRPS-like phenomena following total knee arthroplasty: a preliminary study. Pain 106(3):393–400CrossRefPubMed
10.
go back to reference Parvizi J (2012) Pain management following total joint arthroplasty: making strides. J Bone Joint Surg Am 94(16):1441CrossRefPubMed Parvizi J (2012) Pain management following total joint arthroplasty: making strides. J Bone Joint Surg Am 94(16):1441CrossRefPubMed
11.
go back to reference American Society of Anesthesiologists Task Force on Acute (2012) Pain Management. Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology 116(2):248–273CrossRef American Society of Anesthesiologists Task Force on Acute (2012) Pain Management. Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology 116(2):248–273CrossRef
12.
go back to reference Andersen KV, Bak M, Christensen BV et al (2010) A randomized, controlled trial comparing local infiltration analgesia with epidural infusion for total knee arthroplasty. Acta Orthop 81(5):606–610PubMedCentralCrossRefPubMed Andersen KV, Bak M, Christensen BV et al (2010) A randomized, controlled trial comparing local infiltration analgesia with epidural infusion for total knee arthroplasty. Acta Orthop 81(5):606–610PubMedCentralCrossRefPubMed
13.
go back to reference Carli F, Clemente A, Asenjo JF et al (2010) Analgesia and functional outcome after total knee arthroplasty: periarticular infiltration vs continuous femoral nerve block. Br J Anaesth 105(2):185–195CrossRefPubMed Carli F, Clemente A, Asenjo JF et al (2010) Analgesia and functional outcome after total knee arthroplasty: periarticular infiltration vs continuous femoral nerve block. Br J Anaesth 105(2):185–195CrossRefPubMed
14.
go back to reference Fischer HB, Simanski CJ, Sharp C, PROSPECT Working Group et al (2008) A procedure-specific systematic review and consensus recommendations for postoperative analgesia following total knee arthroplasty. Anaesthesia 63(10):1105–1123CrossRefPubMed Fischer HB, Simanski CJ, Sharp C, PROSPECT Working Group et al (2008) A procedure-specific systematic review and consensus recommendations for postoperative analgesia following total knee arthroplasty. Anaesthesia 63(10):1105–1123CrossRefPubMed
15.
go back to reference Fu P, Wu Y, Wu H et al (2009) Efficacy of intra-articular cocktail analgesic injection in total knee arthroplasty—a randomized controlled trial. Knee 16(4):80–284CrossRef Fu P, Wu Y, Wu H et al (2009) Efficacy of intra-articular cocktail analgesic injection in total knee arthroplasty—a randomized controlled trial. Knee 16(4):80–284CrossRef
16.
go back to reference Lombardi AV Jr, Berend KR, Mallory TH et al (2004) Soft tissue and intra-articular injection of bupivacaine, epinephrine, and morphine has a beneficial effect after total knee arthroplasty. Clin Orthop Relat Res 428:125–130CrossRefPubMed Lombardi AV Jr, Berend KR, Mallory TH et al (2004) Soft tissue and intra-articular injection of bupivacaine, epinephrine, and morphine has a beneficial effect after total knee arthroplasty. Clin Orthop Relat Res 428:125–130CrossRefPubMed
17.
go back to reference Maheshwari AV, Blum YC, Shekhar L et al (2009) Multimodal pain management after total hip and knee arthroplasty at the Ranawat Orthopaedic Center. Clin Orthop Relat Res 467(6):1418–1423PubMedCentralCrossRefPubMed Maheshwari AV, Blum YC, Shekhar L et al (2009) Multimodal pain management after total hip and knee arthroplasty at the Ranawat Orthopaedic Center. Clin Orthop Relat Res 467(6):1418–1423PubMedCentralCrossRefPubMed
18.
go back to reference Parvataneni HK, Ranawat AS, Ranawat CS (2007) The use of local periarticular injections in the management of postoperative pain after total hip and knee replacement: a multimodal approach. Instr Course Lect 56:125–131PubMed Parvataneni HK, Ranawat AS, Ranawat CS (2007) The use of local periarticular injections in the management of postoperative pain after total hip and knee replacement: a multimodal approach. Instr Course Lect 56:125–131PubMed
19.
go back to reference Koh IJ, Kang YG, Chang CB et al (2012) Does periarticular injection have additional pain relieving effects during contemporary multimodal pain control protocols for TKA?: a randomised, controlled study. Knee 19(4):253–259CrossRefPubMed Koh IJ, Kang YG, Chang CB et al (2012) Does periarticular injection have additional pain relieving effects during contemporary multimodal pain control protocols for TKA?: a randomised, controlled study. Knee 19(4):253–259CrossRefPubMed
20.
go back to reference Parker DA, Coolican MR, Mather LE et al (2009) Safety of combined use of local anesthetic infiltration and reinfusion drains in total knee arthroplasty. J Arthroplasty 24(6):918–924CrossRefPubMed Parker DA, Coolican MR, Mather LE et al (2009) Safety of combined use of local anesthetic infiltration and reinfusion drains in total knee arthroplasty. J Arthroplasty 24(6):918–924CrossRefPubMed
21.
go back to reference Van Bastelaere M, Rolly G, Abdullah NM (1995) Postoperative analgesia and plasma levels after transdermal fentanyl for orthopedic surgery: double-blind comparison with placebo. J Clin Anesth 7(1):26–30CrossRefPubMed Van Bastelaere M, Rolly G, Abdullah NM (1995) Postoperative analgesia and plasma levels after transdermal fentanyl for orthopedic surgery: double-blind comparison with placebo. J Clin Anesth 7(1):26–30CrossRefPubMed
22.
go back to reference Minville V, Lubrano V, Bounes V et al (2008) Postoperative analgesia after total hip arthroplasty: patient-controlled analgesia versus transdermal fentanyl patch. J Clin Anesth 20(4):280–283CrossRefPubMed Minville V, Lubrano V, Bounes V et al (2008) Postoperative analgesia after total hip arthroplasty: patient-controlled analgesia versus transdermal fentanyl patch. J Clin Anesth 20(4):280–283CrossRefPubMed
23.
go back to reference Abrisham SM, Ghahramani R, Heiranizadeh N et al (2014) Reduced morphine consumption and pain severity with transdermal fentanyl patches following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 22(7):1580–1584CrossRefPubMed Abrisham SM, Ghahramani R, Heiranizadeh N et al (2014) Reduced morphine consumption and pain severity with transdermal fentanyl patches following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 22(7):1580–1584CrossRefPubMed
24.
go back to reference Sebel PS, Barrett CW, Kirk CJ et al (1987) Transdermal absorption of fentanyl and sufentanil in man. Eur J Clin Pharmacol 32(5):529–531CrossRefPubMed Sebel PS, Barrett CW, Kirk CJ et al (1987) Transdermal absorption of fentanyl and sufentanil in man. Eur J Clin Pharmacol 32(5):529–531CrossRefPubMed
25.
go back to reference Gourlay GK, Kowalski SR, Plummer JL et al (1990) The efficacy of transdermal fentanyl in the treatment of postoperative pain: a double-blind comparison of fentanyl and placebo systems. Pain 40(1):21–28CrossRefPubMed Gourlay GK, Kowalski SR, Plummer JL et al (1990) The efficacy of transdermal fentanyl in the treatment of postoperative pain: a double-blind comparison of fentanyl and placebo systems. Pain 40(1):21–28CrossRefPubMed
26.
go back to reference Lehmann KA, Einnolf C, Eberlein HJ et al (1991) Transdermal fentanyl for the treatment of pain after major urological operations. A randomized double-blind comparison with placebo using intravenous patient-controlled analgesia. Eur J Clin Pharmacol 41(1):17–21CrossRefPubMed Lehmann KA, Einnolf C, Eberlein HJ et al (1991) Transdermal fentanyl for the treatment of pain after major urological operations. A randomized double-blind comparison with placebo using intravenous patient-controlled analgesia. Eur J Clin Pharmacol 41(1):17–21CrossRefPubMed
27.
go back to reference Kilbride M, Morse M, Senagore A (1994) Transdermal fentanyl improves management of postoperative hemorrhoidectomy pain. Dis Colon Rectum 37(11):1070–1072CrossRefPubMed Kilbride M, Morse M, Senagore A (1994) Transdermal fentanyl improves management of postoperative hemorrhoidectomy pain. Dis Colon Rectum 37(11):1070–1072CrossRefPubMed
28.
go back to reference Broome IJ, Wright BM, Bower S et al (1995) Postoperative analgesia with transdermal fentanyl following lower abdominal surgery. Anaesthesia 50(4):300–303CrossRefPubMed Broome IJ, Wright BM, Bower S et al (1995) Postoperative analgesia with transdermal fentanyl following lower abdominal surgery. Anaesthesia 50(4):300–303CrossRefPubMed
29.
go back to reference Miguel R, Kreitzer JM, Reinhart D et al (1995) Postoperative pain control with a new transdermal fentanyl delivery system. A multicenter trial. Anesthesiology 83(3):470–477CrossRefPubMed Miguel R, Kreitzer JM, Reinhart D et al (1995) Postoperative pain control with a new transdermal fentanyl delivery system. A multicenter trial. Anesthesiology 83(3):470–477CrossRefPubMed
30.
go back to reference Ip HY, Abrishami A, Peng PW et al (2009) Predictors of postoperative pain and analgesic consumption: a qualitative systematic review. Anesthesiology 111(3):657–677CrossRefPubMed Ip HY, Abrishami A, Peng PW et al (2009) Predictors of postoperative pain and analgesic consumption: a qualitative systematic review. Anesthesiology 111(3):657–677CrossRefPubMed
31.
go back to reference Sandler AN, Baxter AD, Katz J et al (1994) A double-blind, placebo-controlled trial of transdermal fentanyl after abdominal hysterectomy. Analgesic, respiratory, and pharmacokinetic effects. Anesthesiology 81(5):1169–1180CrossRefPubMed Sandler AN, Baxter AD, Katz J et al (1994) A double-blind, placebo-controlled trial of transdermal fentanyl after abdominal hysterectomy. Analgesic, respiratory, and pharmacokinetic effects. Anesthesiology 81(5):1169–1180CrossRefPubMed
32.
go back to reference Apfel CC, Heidrich FM, Jukar-Rao S et al (2012) Evidence-based analysis of risk factors for postoperative nausea and vomiting. Br J Anaesth 109(5):742–753CrossRefPubMed Apfel CC, Heidrich FM, Jukar-Rao S et al (2012) Evidence-based analysis of risk factors for postoperative nausea and vomiting. Br J Anaesth 109(5):742–753CrossRefPubMed
Metadata
Title
Transdermal fentanyl patch improves post-operative pain relief and promotes early functional recovery in patients undergoing primary total knee arthroplasty: a prospective, randomised, controlled trial
Authors
Shigemi Matsumoto
Kazu Matsumoto
Hiroki Iida
Publication date
01-09-2015
Publisher
Springer Berlin Heidelberg
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 9/2015
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-015-2265-z

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