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COMPARISON OF TRANSDERMAL FENTANYL AND MODIFIED RELEASE OXYCODONE AS BACKGROUND ANALGESIA FOR TOTAL KNEE ARTHROPLASTY IN AN ENHANCED RECOVERY PROGRAM: A RETROSPECTIVE OBSERVATIONAL STUDY
ESRA Academy. Rappai G. Sep 8, 2016; 138196
Topic: ACUTE PAIN SERVICE (APS) - PAIN MANAGEMENT AT HOME
Dr. Geejo Rappai
Dr. Geejo Rappai

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Abstract
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Background and Aims:

Transdermal fentanyl patches have been used at our institution for 5 years as background analgesia in TKR.  Alternatively, we use oxycodone MR, more widely used in knee arthroplasty.  We sought to compare analgesic efficacy, PONV and sedation between the two modalities in the context of an enhanced recovery program.

Methods:

Methods:

Methods:

We consulted the local ethics committee who approved our study, then collected data retrospectively from 352 consecutive patients undergoing knee arthroplasty.

Each patient had a spinal anaesthetic without opioids and a caledonian intra-articular catheter sited during surgery.  The patients received either a low dose fentanyl patch (12mcg/hr) applied preoperatively or 3 doses of oxycodone MR 10mg according to the anaesthetist's normal practice.  Pain scores, breakthrough analgesia use, incidence of PONV and sedation were all collected routinely (until post operative day 2) by pain nurses, independently of investigators. 

Analysis of data was performed by a statistician using IBM SPSS statistics software on a complete case basis.

Results:

Results:

The median PRN analgesia use in each group was 50mg oxycodone IR (IQR 40.) 

Pain scores for fentanyl (dark grey) and oxycodone (light grey) on post-operative day 1 are shown graphically below.




PONV was significantly lower in the fentanyl group (p=0.004).  Sedation was negligible in both groups.

Conclusions:

Conclusions:

Analgesia was very similar in each group. PONV was lower in the fentanyl group. The total cost of administering oxycodone MR was higher than fentanyl patches.  We therefore conclude that fentanyl is a safe and cost effective alternative in TKR surgery as part of an enhanced recovery program.

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