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Respiratory changes during treatment of postoperative pain with high dose transdermal fentanyl
Author(s) -
Bülow H. H.,
Linnemann M.,
Berg H.,
LangJensen T.,
LaCour S.,
Jonsson T.
Publication year - 1995
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.1995.tb04180.x
Subject(s) - medicine , fentanyl , anesthesia , sedation , transdermal , analgesic , placebo , respiratory rate , respiratory system , heart rate , blood pressure , pharmacology , alternative medicine , pathology
This study made a longterm (72 hours) evaluation of the efficacy and possible side‐effects of transdermal delivery of fentanyl (TTS‐system) for post‐operative pain relief. The study was double‐blind, placebo‐controlled with either a TTS‐system delivering fentanyl 100 μg · h ‐1 and rescue analgesic on demand or a placebo system and analgesic on demand. Analgesic consumption, pain, general satisfaction, respiratory rate, and levels of SpO 2 and tcCO 2 (pulse oximetry and transcutaneous CO 2 measuring) were evaluated. Recruitment was stopped after enrolment of 24 patients, on safety grounds. The Fentanyl group was more satisfied with postoperative pain relief ( P = 0.008); they had a lower analgesic demand ( P <0.05) but also a lower respiratory rate ( P <0.05) and a higher level of tcCO 2 23 hours after application ( P <0.05). There were three cases (25%) of increased PaCO 2 (>6.5 kPa) in the Placebo group but without low PaO 2 levels, sedation or bradypnoea. Conversely, there were three cases (33%) in the Fentanyl group with bradypnoea (<10 breaths/minute), two without influence on PaO 2 or PaCO 2 , but one (no. 24) with bradypnoea, heavy sedation, a marked decrease in PaO 2 (5.8 kPa) and increased PaCO 2 (7.5 kPa). These findings terminated the study. The 100 μg transdermal fentanyl system is agreeable to the patients, but apparently too potent for routine postoperative pain relief due to a risk of respiratory depression. Respiratory frequency can not be relied upon as sole indicator of insufficient respiration.