Skip to main content

Advertisement

SpringerLink
Log in

Transdermal fentanyl patch improves post-operative pain relief and promotes early functional recovery in patients undergoing primary total knee arthroplasty: a prospective, randomised, controlled trial

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The aim of the present study was to evaluate the efficacy and safety of a 12.5 μg/h transdermal fentanyl patch (TFP).

Materials and Methods

Fifty-two patients scheduled for primary total knee arthroplasty (TKA) were recruited in the study. They were randomly divided into two groups: patients provided with a transdermal fentanyl patch (Group TFP) and those provided with non-steroid anti-inflammatory drugs (Group NSAID). The patients in the TFP and NSAID groups had mean ages of 70.1 years (range 36–86 years) and 73.5 years (range 32–86 years), respectively. Post-operative pain intensity was measured using the visual analogue scale both at rest and during movement (mVAS). We also evaluated lower leg functional recovery and adverse events.

Results

The mean mVAS scores were not different between the two groups on post-operative day 4, but were significantly smaller in the TFP group than in the NSAID group on post-operative days 7 (p = 0.0026) and 14 (p = 0.007). Muscle strength recovered faster in the TFP group than in the NSAID group, the percentage of pre-operative strength being significantly greater in the former than in the latter on post-operative days 7 (p = 0.027) and 14 (p = 0.047). Furthermore, there were no remarkable adverse events in patients using TFP.

Conclusion

We conclude that a 12.5 μg/h TFP can improve post-operative pain relief and promotes early functional recovery following total knee arthroplasty.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Hawker G, Wright J, Coyte P et al (1998) Health-related quality of life after knee replacement. J Bone Joint Surg Am 80(2):163–173

    CAS  PubMed  Google Scholar 

  2. Meding JB, Meding LK, Ritter MA et al (2012) Pain relief and functional improvement remain 20 years after knee arthroplasty. Clin Orthop Relat Res 470(1):144–149

    Article  PubMed Central  PubMed  Google Scholar 

  3. Norman-Taylor FH, Palmer CR, Villar RN (1996) Quality-of-life improvement compared after hip and knee replacement. J Bone Joint Surg Br 78(1):74–77

    CAS  PubMed  Google Scholar 

  4. Chelly JE, Ben-David B, Williams BA et al (2003) Anesthesia and postoperative analgesia: outcomes following orthopedic surgery. Orthopedics. 26(8 Suppl):s865–s871 (Review)

    PubMed  Google Scholar 

  5. Cheville A, Chen A, Oster G et al (2001) A randomized trial of controlled-release oxycodone during inpatient rehabilitation following unilateral total knee arthroplasty. J Bone Joint Surg Am 83-A(4):572–576

    CAS  PubMed  Google Scholar 

  6. Modig J, Borg T, Karlström G et al (1983) Thromboembolism after total hip replacement: role of epidural and general anesthesia. Anesth Analg 62(2):174–180

    Article  CAS  PubMed  Google Scholar 

  7. Rodgers A, Walker N, Schug S et al (2000) Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ 321(7275):1493

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  8. Singelyn FJ, Deyaert M, Joris D et al (1998) Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous three-in-one block on postoperative pain and knee rehabilitation after unilateral total knee arthroplasty. Anesth Analg 87(1):88–92

    CAS  PubMed  Google Scholar 

  9. Harden RN, Bruehl S, Stanos S et al (2003) Prospective examination of pain-related and psychological predictors of CRPS-like phenomena following total knee arthroplasty: a preliminary study. Pain 106(3):393–400

    Article  PubMed  Google Scholar 

  10. Parvizi J (2012) Pain management following total joint arthroplasty: making strides. J Bone Joint Surg Am 94(16):1441

    Article  PubMed  Google Scholar 

  11. American Society of Anesthesiologists Task Force on Acute (2012) Pain Management. Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology 116(2):248–273

    Article  Google Scholar 

  12. Andersen KV, Bak M, Christensen BV et al (2010) A randomized, controlled trial comparing local infiltration analgesia with epidural infusion for total knee arthroplasty. Acta Orthop 81(5):606–610

    Article  PubMed Central  PubMed  Google Scholar 

  13. Carli F, Clemente A, Asenjo JF et al (2010) Analgesia and functional outcome after total knee arthroplasty: periarticular infiltration vs continuous femoral nerve block. Br J Anaesth 105(2):185–195

    Article  CAS  PubMed  Google Scholar 

  14. Fischer HB, Simanski CJ, Sharp C, PROSPECT Working Group et al (2008) A procedure-specific systematic review and consensus recommendations for postoperative analgesia following total knee arthroplasty. Anaesthesia 63(10):1105–1123

    Article  CAS  PubMed  Google Scholar 

  15. Fu P, Wu Y, Wu H et al (2009) Efficacy of intra-articular cocktail analgesic injection in total knee arthroplasty—a randomized controlled trial. Knee 16(4):80–284

    Article  Google Scholar 

  16. Lombardi AV Jr, Berend KR, Mallory TH et al (2004) Soft tissue and intra-articular injection of bupivacaine, epinephrine, and morphine has a beneficial effect after total knee arthroplasty. Clin Orthop Relat Res 428:125–130

    Article  PubMed  Google Scholar 

  17. Maheshwari AV, Blum YC, Shekhar L et al (2009) Multimodal pain management after total hip and knee arthroplasty at the Ranawat Orthopaedic Center. Clin Orthop Relat Res 467(6):1418–1423

    Article  PubMed Central  PubMed  Google Scholar 

  18. Parvataneni HK, Ranawat AS, Ranawat CS (2007) The use of local periarticular injections in the management of postoperative pain after total hip and knee replacement: a multimodal approach. Instr Course Lect 56:125–131

    PubMed  Google Scholar 

  19. Koh IJ, Kang YG, Chang CB et al (2012) Does periarticular injection have additional pain relieving effects during contemporary multimodal pain control protocols for TKA?: a randomised, controlled study. Knee 19(4):253–259

    Article  PubMed  Google Scholar 

  20. Parker DA, Coolican MR, Mather LE et al (2009) Safety of combined use of local anesthetic infiltration and reinfusion drains in total knee arthroplasty. J Arthroplasty 24(6):918–924

    Article  PubMed  Google Scholar 

  21. Van Bastelaere M, Rolly G, Abdullah NM (1995) Postoperative analgesia and plasma levels after transdermal fentanyl for orthopedic surgery: double-blind comparison with placebo. J Clin Anesth 7(1):26–30

    Article  PubMed  Google Scholar 

  22. Minville V, Lubrano V, Bounes V et al (2008) Postoperative analgesia after total hip arthroplasty: patient-controlled analgesia versus transdermal fentanyl patch. J Clin Anesth 20(4):280–283

    Article  PubMed  Google Scholar 

  23. Abrisham SM, Ghahramani R, Heiranizadeh N et al (2014) Reduced morphine consumption and pain severity with transdermal fentanyl patches following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 22(7):1580–1584

    Article  PubMed  Google Scholar 

  24. Sebel PS, Barrett CW, Kirk CJ et al (1987) Transdermal absorption of fentanyl and sufentanil in man. Eur J Clin Pharmacol 32(5):529–531

    Article  CAS  PubMed  Google Scholar 

  25. Gourlay GK, Kowalski SR, Plummer JL et al (1990) The efficacy of transdermal fentanyl in the treatment of postoperative pain: a double-blind comparison of fentanyl and placebo systems. Pain 40(1):21–28

    Article  CAS  PubMed  Google Scholar 

  26. Lehmann KA, Einnolf C, Eberlein HJ et al (1991) Transdermal fentanyl for the treatment of pain after major urological operations. A randomized double-blind comparison with placebo using intravenous patient-controlled analgesia. Eur J Clin Pharmacol 41(1):17–21

    Article  CAS  PubMed  Google Scholar 

  27. Kilbride M, Morse M, Senagore A (1994) Transdermal fentanyl improves management of postoperative hemorrhoidectomy pain. Dis Colon Rectum 37(11):1070–1072

    Article  CAS  PubMed  Google Scholar 

  28. Broome IJ, Wright BM, Bower S et al (1995) Postoperative analgesia with transdermal fentanyl following lower abdominal surgery. Anaesthesia 50(4):300–303

    Article  CAS  PubMed  Google Scholar 

  29. Miguel R, Kreitzer JM, Reinhart D et al (1995) Postoperative pain control with a new transdermal fentanyl delivery system. A multicenter trial. Anesthesiology 83(3):470–477

    Article  CAS  PubMed  Google Scholar 

  30. Ip HY, Abrishami A, Peng PW et al (2009) Predictors of postoperative pain and analgesic consumption: a qualitative systematic review. Anesthesiology 111(3):657–677

    Article  PubMed  Google Scholar 

  31. Sandler AN, Baxter AD, Katz J et al (1994) A double-blind, placebo-controlled trial of transdermal fentanyl after abdominal hysterectomy. Analgesic, respiratory, and pharmacokinetic effects. Anesthesiology 81(5):1169–1180

    Article  CAS  PubMed  Google Scholar 

  32. Apfel CC, Heidrich FM, Jukar-Rao S et al (2012) Evidence-based analysis of risk factors for postoperative nausea and vomiting. Br J Anaesth 109(5):742–753

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan

    Shigemi Matsumoto & Hiroki Iida

  2. Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan

    Kazu Matsumoto

Authors
  1. Shigemi Matsumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kazu Matsumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hiroki Iida
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hiroki Iida.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (JPEG 491 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Matsumoto, S., Matsumoto, K. & Iida, H. Transdermal fentanyl patch improves post-operative pain relief and promotes early functional recovery in patients undergoing primary total knee arthroplasty: a prospective, randomised, controlled trial. Arch Orthop Trauma Surg 135, 1291–1297 (2015). https://doi.org/10.1007/s00402-015-2265-z

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-015-2265-z

Keywords

Search

Navigation