Thakur Deepak, Ravupalli Shashikant, Rao Sruthi, Ukey Viplove, Pandit Manish, Aftab Aafreen
Department of Oral and Maxillofacial Surgery, Rungta College of Dental Sciences and Research, Bhilai, India.
V Y Institute of Medical Sciences, VY Hospital, Raipur, India.
J Maxillofac Oral Surg. 2023 Sep;22(3):609-613. doi: 10.1007/s12663-022-01820-4. Epub 2022 Dec 2.
Removal of mandibular third molars surgically is one of the most frequently performed oral surgical procedures which are often accompanied with post-operative pain, swelling and trismus. Despite general progress in pain management, moderate to severe acute post-operative pain after removal of lower third molars remains a problem. Fentanyl is an extremely effective drug in the treatment of severe chronic pain such as cancer pain and post-operative pains which acts by increasing patient's tolerance to pain. Fentanyl Transdermal System (FTS) is a rectangular transdermal patch which contains high concentration of fentanyl, a potent short-acting Schedule II opiate. In this study the efficacy of transdermal fentanyl for management of post-operative pain after impacted mandibular 3rd molar surgery is evaluated.
20 patients within the age group of 18-40 years with asymptomatic impacted mandibular third molars were equally divided into 2 groups as group A & group B which underwent surgery in Local Anaesthesia. In every patient one side belonged to group A and other side belonged to group B. 50 μg FTS was applied in group A while placebo patch was applied in group B.
Patients in group A performed significantly better than group B in terms of mean pain intensity scores assessed by VAS and VRS along with minimum need of post-operative rescue analgesics.
It was found that FTS resulted in significantly better pain relief, longer pain-free intervals, and lesser post-operative analgesic consumption.
手术拔除下颌第三磨牙是最常进行的口腔外科手术之一,术后常伴有疼痛、肿胀和牙关紧闭。尽管在疼痛管理方面取得了总体进展,但拔除下颌第三磨牙后的中度至重度急性术后疼痛仍然是一个问题。芬太尼是治疗严重慢性疼痛(如癌症疼痛和术后疼痛)的极其有效的药物,它通过提高患者对疼痛的耐受性来发挥作用。芬太尼透皮系统(FTS)是一种长方形的透皮贴剂,含有高浓度的芬太尼,一种强效短效的II类阿片制剂。在本研究中,评估了透皮芬太尼对下颌阻生第三磨牙手术后疼痛管理的疗效。
将20例年龄在18 - 40岁、无症状的下颌阻生第三磨牙患者平均分为A组和B组,两组均在局部麻醉下进行手术。每位患者一侧属于A组,另一侧属于B组。A组应用50μg的芬太尼透皮贴剂,B组应用安慰剂贴剂。
在通过视觉模拟评分法(VAS)和视觉疼痛评分法(VRS)评估的平均疼痛强度评分以及术后急救镇痛药的最低需求量方面,A组患者的表现明显优于B组。
研究发现,芬太尼透皮系统能显著更好地缓解疼痛,延长无痛间隔时间,并减少术后镇痛药的用量。