Transdermal Ketoprofen Versus Fentanyl Patches for Pain Management Post-cesarean Section: A Comparative, Randomized, Double-Blind Study.

INTRODUCTION

Postoperative pain management after a cesarean section is essential to promote mother-infant bonding and ease of breastfeeding. Transdermal patches present a viable alternative to oral medications, offering controlled drug delivery and better bioavailability while avoiding first-pass metabolism, all of which can facilitate smoother recovery and rehabilitation.

METHODS

This comparative, randomized, double-blind study was conducted on 70 parturients scheduled for cesarean section under spinal anesthesia, classified as ASA II. Patients were randomly divided into two groups: Group K (transdermal ketoprofen patch, 30 mg) and Group F (transdermal fentanyl patch, 25 mcg). The patches were applied immediately after spinal anesthesia. Pain was assessed using the Visual Analogue Scale (VAS), and sedation was assessed using the Richmond Agitation-Sedation Scale for 24 hours.

RESULTS

There was no statistically significant difference in the VAS scores between the two groups from two to 14 hours postoperatively. However, a statistically significant difference was observed at 16 hours (Group K 2 ± 0.87 vs. Group F 2.5 ± 0.86, p = 0.029) and 20 hours (Group K 1.77 ± 0.86 vs. Group F 2.33 ± 0.8, p = 0.011). Rescue analgesia was required in seven (20%) of the patients in Group K and 12 (34.29%) of the patients in Group F, though this difference was not statistically significant. At 20 hours, Group K had more alert and calm patients (33 (94.29%) vs. 26 (74.29%)), with fewer drowsy or restless patients compared to Group F (p = 0.044). At 24 hours, Group K had significantly fewer drowsy patients (0 (0%) vs. 13 (37.14%)) and more alert patients (34 (97.14%) vs. 19 (54.29%)), with fewer restless patients (p < 0.0001).

CONCLUSION

Both the ketoprofen patch (30 mg) and the fentanyl patch (25 mcg) provided comparable analgesia for the first 12 hours. However, at 16 and 20 hours, the ketoprofen patch was more effective than the fentanyl patch in providing analgesia. More patients in the fentanyl group were drowsy after 16 hours, though normal sleep patterns may have contributed to this observation.