Comparison of Thoracic Analgesia with Epidural Fentanyl and Transdermal Fentanyl Patch: A Comparitive Prospective Randomized Study

Abstract

Background: Thoracic epidural analgesia (TEA) is used for analgesia following lower abdomen or orthopaedic surgeries. The aim of study was To compare the effects of 0.125% Bupivacaine with 2mcg/ml of Fentanyl infusion (group A) and 0.125% Bupivacaine with fentanyl patch (group B). Methods: Patients undergoing elective surgery were randomized in a non-blinded fashion to receive postoperative analgesia at a single teaching hospital. A nested qualitative study (reported elsewhere) explored the dual primary outcome of patient experience and acceptability. Secondary outcome measures included rest and movement pain scores over 72 h, functional analgesia, analgesia satisfaction, opiate consumption, functional recovery, morbidity, safety, and cost-effectiveness. Results: A total of 40 patients were randomized. The median (interquartile range; i.q.r.) dynamic pain score at 24 h was significantly lower after TEA than RSCA (33 (11–60) versus 50.5 (24.50–77.25); P = 0.018). Resting pain score at 72 h was significantly lower (4.5 (0.25–13.75) versus 12.5 (2–13); P = 0.019). Opiate consumption on postoperative day 3 (median (i.q.r.) morphine equivalent 17 (10–30) mg versus 40 (13.25–88.50) mg; P = 0.038), hypotension, or vasopressor dependency (29.7 versus 49.2 per cent; P = 0.023) and weight gain to day 3 (median (i.q.r.) 0 (−1–2) kg versus 1 (0–3) kg; P = 0.046) were all significantly greater after TEA. Conclusions: TEA provided superior initial postoperative analgesia but only for the first 24 h. By 72 hours and provides superior analgesia, is associated with a lower incidence of unwanted effects, and may be more costeffective.