Bakeer Ahmed H, Abdallah Nasr M
Department of Anaesthesia and Pain Relief, National Cancer Institute, Cairo University, Giza, Egypt.
Lecturer of Anesthesiology, Faculty of Medicine, Cairo University, Giza, Egypt.
Saudi J Anaesth. 2017 Oct-Dec;11(4):384-389. doi: 10.4103/sja.SJA_84_17.
The aim of this study is to investigate the effect of transdermal fentanyl (TDF) as an adjuvant to paravertebral block (PVB) for pain control after breast cancer surgery.
This randomized, double-blind trial included fifty females with breast cancer scheduled for surgery. They were randomly allocated into one of two equal groups. The TDF group used transdermal fentanyl patches (TFPs) 25 μg/h applied 10 h preoperative then PVB with 20 mL of bupivacaine 0.25% was done before induction of general anesthesia. The PVB group used placebo patches in addition to PVB the same way as TDF group. Postoperative pain was assessed with a visual analog scale (VAS) score up to 48 h. Intravenous morphine 0.1 mg/kg was given when the VAS is ≥ 3 or on patient request. The primary outcome measures were the time to first request for analgesia and the total analgesic consumption in the first 48 h.
Relative to the VAS score reading was 30 min. After the end of surgery, VAS score decreased significantly in the two groups up to 48 postoperative hours and was significantly lower in TDF group up to 24 h. The time to first request of additional analgesia was significantly longer, and total dose of morphine consumption was significantly lower in TDF group ( < 0.001, and = 0.039, respectively).
TFPs releasing 25 μg/h is a safe and effective adjuvant to PVB after breast cancer surgery. It provides adequate analgesia with reduction of opioid consumption and minimal adverse effects.
本研究旨在探讨透皮芬太尼（TDF）作为椎旁阻滞（PVB）辅助用药对乳腺癌手术后疼痛控制的效果。
这项随机、双盲试验纳入了50例计划接受手术的乳腺癌女性患者。她们被随机分为两组，每组人数相等。TDF组在术前10小时使用25μg/h的透皮芬太尼贴剂（TFP），然后在全身麻醉诱导前进行20mL 0.25%布比卡因的PVB。PVB组除了以与TDF组相同的方式进行PVB外，还使用了安慰剂贴剂。术后使用视觉模拟量表（VAS）评分评估疼痛情况，持续48小时。当VAS评分≥3或患者要求时，给予静脉注射吗啡0.1mg/kg。主要观察指标为首次要求镇痛的时间和前48小时的总镇痛药物消耗量。
相对于VAS评分读数为30分钟。手术后，两组的VAS评分在术后48小时内均显著下降，且TDF组在术后24小时内显著更低。TDF组首次要求追加镇痛的时间显著更长，吗啡总消耗量显著更低（分别为<0.001和=0.039）。
释放25μg/h的TFP是乳腺癌手术后PVB的一种安全有效的辅助用药。它能提供充分的镇痛效果，减少阿片类药物的消耗，且不良反应最小。
