Egger Christine M, Glerum Leigh, Michelle Haag Katherine, Rohrbach Barton W
Department of Small Animal Medicine and Surgery, University of Georgia, Athens, GA, USA.
Vet Anaesth Analg. 2007 May;34(3):200-8. doi: 10.1111/j.1467-2995.2006.00310.x.
To determine whether transdermal fentanyl patches provided cost-effective post-operative analgesia in dogs with pelvic limb injuries.
Prospective, randomized, blinded clinical trial.
Twenty-four dogs undergoing repair of ruptured cranial cruciate ligaments or pelvic limb fractures.
Dogs were randomly assigned to one of two groups: those receiving transdermal fentanyl patches (group F) and those receiving injectable morphine for control of post-operative pain (group M). Patients in both treatment groups were monitored for adequacy of analgesia and alterations in physiological variables. Plasma fentanyl concentrations were measured in Group F. Rescue morphine was given if a dog was deemed uncomfortable. The time of first rescue morphine, the total amount, and number of doses of morphine administered over 72 hours was quantified and compared for each group.
There was no significant treatment effect on any of the parameters, except for serum cortisol concentration, which was significantly lower overall in group F (p = 0.01). Pain scores peaked at 6 hours post-extubation and were higher than baseline from 2 to 20 hours post-extubation. Cortisol concentrations were the highest at time 0 (extubation) and were significantly higher than baseline until 2 hours post-extubation. Pain scores correlated with fentanyl plasma concentrations (p = 0.0001 and p = 0.01, respectively), but the correlation was low (r = 0.26 and r = 0.16, respectively). No correlation was found between serum cortisol concentrations and pain scores in either group. Fentanyl cost and total cost for pain management were considerably higher for group F.
Fentanyl patches did not provide better analgesia or a reduced requirement for rescue opioid compared with intramuscular morphine.
When considering overall costs to the client for comparable analgesic intervention, fentanyl patches increased rather than decreased cost during the first 24 hours post-operatively.
确定透皮芬太尼贴剂是否能为患有盆腔肢体损伤的犬提供具有成本效益的术后镇痛。
前瞻性、随机、盲法临床试验。
24只接受颅交叉韧带破裂或盆腔肢体骨折修复的犬。
将犬随机分为两组：一组接受透皮芬太尼贴剂（F组），另一组接受注射用吗啡以控制术后疼痛（M组）。对两个治疗组的患者进行镇痛充分性和生理变量变化的监测。在F组中测量血浆芬太尼浓度。如果犬被认为不适，则给予急救吗啡。对每组首次使用急救吗啡的时间、72小时内给予的吗啡总量和剂量数进行量化并比较。
除血清皮质醇浓度外，对任何参数均无显著治疗效果，F组的血清皮质醇浓度总体显著较低（p = 0.01）。疼痛评分在拔管后6小时达到峰值，在拔管后2至20小时高于基线。皮质醇浓度在时间0（拔管）时最高，直到拔管后2小时显著高于基线。疼痛评分与芬太尼血浆浓度相关（分别为p = 0.0001和p = 0.01），但相关性较低（分别为r = 0.26和r = 0.16）。两组中血清皮质醇浓度与疼痛评分之间均未发现相关性。F组的芬太尼成本和疼痛管理总成本要高得多。
与肌肉注射吗啡相比，芬太尼贴剂并未提供更好的镇痛效果或减少急救阿片类药物的需求。
在考虑为客户提供类似镇痛干预的总体成本时，芬太尼贴剂在术后头24小时内增加而非降低了成本。
