Reducing Postoperative Opioid Consumption by Adding Transdermal Fentanyl Patches to Multimodal Analgesia after Breast Cancer Surgery

Abstract

Background: Breast surgeries are among the common forms of surgeries that conducted daily in hospitals. Multimodal analgesia, which combines analgesics with variable pharmacodynamics to target multiple underlying mechanisms of pain, is evolving as an acceptable approach to pain treatment for acute pain. So Transdermal fentanyl patch (TDF) can ameliorate severe pain in breast surgery. Objective: To examine the efficacy and safety of adding Transdermal fentanyl patch (TDF) to multimodal analgesia in controlling acute postoperative pain after breast surgery if applied 12 hours prior surgery. Methods: This randomized, blinded, study was conducted after approval of local ethics committee of South Egypt Cancer Institute, Assiut University, Assiut–Egypt, and registered at www.clinicaltrials.gov at no.: “NCT03051503”. After obtaining written informed consent, Sixty four adult female patients (ASA II) were scheduled for elective breast cancer surgeries in the form of modified radical mastectomy. Patients were classified randomly into two groups (32 patients each) to receive beside standard GA, Transdermal fentanyl patch (TDF) 50 μg/hr applied 12 hours prior surgery in one group (TDF group), while the second group (control group) received standard GA alone. Both group treated by morphine PCA for postoperative pain. Visual analogue scale (VAS), side effects, and serum levels of cortisol and prolactin were assessed over 24 h. postoperatively. The intra and post-operative heart rate (HR) and mean arterial pressure (MAP), Ramsay sedation score and total morphine consumption via PCA postoperatively were also recorded. Results: MAP and heart rate during intra and early post-operative periods were significantly reduced in TDF group in comparison to control group (P ≤ 0.005) but not over the remaining post-operative period (P>0.01). And, there was significant decrease in both VAS scores (p<0.05) and hence the total amount of morphine consumed postoperatively (7.43 ± 4.39) in TDF group in comparison to control group (13.47 ± 4.73) without significant change in side effects, except sedation scores, which were statistically increased but clinically not effective, in early post-operative hours. Finally, levels of prolactin and cortisol hormones were significantly decreased in TDF group indicating less stress and better pain control. Conclusion: Applying Transdermal fentanyl patch (TDF) 50 μg/hr 12 hours prior surgery as a part of multimodal analgesia to control acute postoperative pain after modified radical mastectomy was associated with less stress response, better pain control and decreased total amount of postoperative morphine consumption.