Gourlay Geoffrey K, Kowalski Stefan R, Plummer John L, Cherry David A, Gaukroger Philip, Cousins Michael J
Pain Management Unit, Department of Anaesthesia and Intensive Care, Flinders Medical Centre, Bedford Park, S.A. 5042 Australia.
Pain. 1989 May;37(2):193-202. doi: 10.1016/0304-3959(89)90130-9.
A transdermal formulation of fentanyl (TTS-fentanyl, Alza Corp., Palo Alto, CA) was evaluated in 13 surgical patients after an abdominal operation. An intraoperative dose of fentanyl (100-200 micrograms i.v.) was administered at the same time as the TTS-fentanyl systems (50-125 micrograms/h) were applied to the antero-lateral chest wall. The TTS-fentanyl systems remained in situ for 24 h and were then removed and a second lot of systems were applied to the contra-lateral chest wall. There was a mean (S.D.) delay time of 12.7 (9.6) h before minimum effective blood fentanyl concentrations (MEC) were obtained from the systems and pseudo-steady state was reached between 36 and 48 h. There was a decay time of 16.1 (7.1) h after the systems were removed for the blood fentanyl concentration to decrease to less than the mean MEC for the control of postoperative pain. There was marked variability between patients in the actual hourly fentanyl dose rate determined from the residual amount of fentanyl remaining in the system and the duration of application. Significantly more supplementary pethidine was administered for inadequate postoperative analgesia between 0 and 12 h compared to the 12-24, 24-36 and 36-48 h periods; this was consistent with the observed delay time. Three patients required a reduction in the hourly fentanyl dose rate because of bradypnoea while 1 patient required an increase in dose because of inadequate pain relief. Nausea was the most frequently reported side effect (85% of patients) while bradypnoea, drowsiness, unpleasant dreams and headache were also reported. These effects were due to the combined effects of a sustained blood fentanyl concentration and the intermittent supplementary pethidine doses. Side effects due to the topical formulation were transient and included erythema (8 patients) and a minor rash (2 patients) in the area occluded by the systems. The TTS-fentanyl systems provided a significant contribution to postoperative pain control but, at the TTS dose rates used, supplementary doses of pethidine were required by all patients probably to control 'incident' pain.
对13例腹部手术后的外科患者评估了芬太尼透皮制剂（TTS-芬太尼，阿尔扎公司，加利福尼亚州帕洛阿尔托）。在将TTS-芬太尼系统（50-125微克/小时）应用于前胸壁的同时，静脉注射术中剂量的芬太尼（100-200微克）。TTS-芬太尼系统原位保留24小时，然后移除，并在对侧胸壁应用第二批系统。从系统中获得最低有效血芬太尼浓度（MEC）之前的平均（标准差）延迟时间为12.7（9.6）小时，在36至48小时之间达到伪稳态。系统移除后，血芬太尼浓度降至低于用于控制术后疼痛的平均MEC的衰减时间为16.1（7.1）小时。根据系统中剩余芬太尼的残留量和应用持续时间确定的实际每小时芬太尼剂量率在患者之间存在明显差异。与12-24、24-36和36-48小时相比，0至12小时期间因术后镇痛不足而给予的补充哌替啶明显更多；这与观察到的延迟时间一致。3例患者因呼吸过缓需要降低每小时芬太尼剂量率，而1例患者因疼痛缓解不足需要增加剂量。恶心是最常报告的副作用（85%的患者），同时也报告了呼吸过缓、嗜睡、不愉快的梦境和头痛。这些效应是由于持续的血芬太尼浓度和间歇性补充哌替啶剂量的综合作用。局部制剂引起的副作用是短暂的，包括系统覆盖区域的红斑（8例患者）和轻微皮疹（2例患者）。TTS-芬太尼系统对术后疼痛控制有显著贡献，但在所使用的TTS剂量率下，所有患者可能都需要补充哌替啶剂量来控制“突发”疼痛。
