RESUMO
Background: One of the most common fractures in the elderly population is a fracture of the neck of femur. Effective post-operative analgesia is a major challenge. Age-related co-morbidities restrict the choice of analgesics. The purpose of this study was to compare the efficacy and safety of transdermal buprenorphine [TDB] patch and conventional analgesics following hemiarthroplasty for intra-capsular fracture neck of femur. Materials and methods: This was a prospective, randomized control study done in 60 patients undergoing hemiarthroplasty for intra-capsular fracture neck of femur over a period of 2 years. Patients were randomized in 2 groups. Group A received a combination of IV paracetamol and tramadol for first 48 h followed by oral formulation. In Group B patients, a transdermal buprenorphine patch of 5 mcg/h was applied at the beginning of surgery and was continued 2 weeks post-operative.Pain score by VAS was observed both at rest and on movement and followed up till 14 days post-operative. Primary target was to maintain a VAS ≤ 4. Rescue analgesic was given if the VAS was ≥ 6. Secondary targets were number of rescue analgesics required, adverse reactions and complications if any. Results: Group B had significantly lower pain scores at rest and during movement [p value 0.0012 to ≤ 0.0001], so was rescue analgesia requirement. No significant side effects were seen in TDB group. Conclusion: TDB patch is safe and provides superior analgesia and compliance as compared to conventional analgesics in the post-operative period in proximal femur fracture surgeries.
RESUMO
BACKGROUND: Total knee arthroplasty (TKA) is associated with moderate-to-severe postoperative pain. Satisfactory perioperative analgesia is essential for a good and predictable surgical outcome. Effective postoperative pain control is a major challenge to the treating surgeon and his team. Old age and multiple comorbidities restrict the choice of analgesics one can offer. Transdermal buprenorphine (TDB), widely used in chronic pain management, has been rarely studied in acute postoperative setting. The purpose of this study was to compare the safety and efficacy of a TDB patch to conventional analgesics after knee arthroplasty surgery. METHODS: A prospective randomized study was conducted with 200 patients aged 60-75 years undergoing TKA surgery under neuraxial anesthesia. All patients received periarticular local anesthetic infiltration and epidural/femoral nerve block infusion for 72 hours postoperatively. Group A received the TDB patch 5 mcg applied at the end of surgery. Group B received a combination of paracetamol and tramadol. All patients received intravenous diclofenac as rescue analgesia. Pain scores at rest, on movement, and side effects, if any, were compared over 7 days using the numerical rating scale score. RESULTS: Pain scores at rest and on movement were significantly lower in group A (P values .008 and .01). Rescue analgesia requirement was also significantly less in this group. Only one patient had clinically significant respiratory depression, and 3 patients had local erythema. CONCLUSION: Our data shows that the TDB patch is more efficacious in reducing postoperative pain after TKA surgery and can be safely used with fewer systemic side effects when compared to conventional analgesics.
