Korean J Clin Pharm.  2018 Mar;28(1):17-23. 10.24304/kjcp.2018.28.1.17.

Comparison of Propacetamol plus Fentanyl and Fentanyl alone with Patient Controlled Analgesia after Total Knee Arthroplasty

• Kim M
• Jeong H
• Park S
• Rhie SJ

• KMID: 2439733
• DOI: http://doi.org/10.24304/kjcp.2018.28.1.17

Abstract

OBJECTIVE
Opioid analgesics, for postoperative pain management, are an indispensable group of medication; however, they also have a variety of adverse drug reactions (ADR). Multimodal methods, combining non-opioid analgesics with opioid analgesics, have been investigated to increase the effects of analgesics and reduce ADR with opioid-sparing effects. The purpose of this study was to compare the effects of patient-controlled analgesia (PCA) with fentanyl alone, and PCA with fentanyl and intravenous (i.v.) propacetamol to determine the effects of pain control, cumulative opioid usage, and opioid ADR.
METHODS
The subjects were patients who underwent total knee arthroplasty at the Seoul Veterans hospital from January 1, 2015 to December 31, 2016. The study period was from postoperative day 0 (POD0) to day 3 (POD3), and the retrospective study was conducted using electronic medical records.
RESULTS
Pain severity was significantly low at POD1 (p = 0.017), POD2 (p = 0.003), and POD3 (p = 0.002) in the multimodal group. The fentanyl only group frequently reported both moderate and severe pain at a statistically significant level. This was consistent with the analysis of the pro re nata (PRN) intramuscular analgesia usage at the time of numerical rating scale (NRS) 4 and above. The opioid-sparing effect confirmed that the average opioid dose equivalent to i.v. morphine dose was 9.4 mg more than that used for the multimodal group in the fentanyl only group. The ADRs and length of stay between the two groups were not statistically different.
CONCLUSION
The results of this study suggest that the combination therapy of fentanyl and i.v. propacetamol is superior to fentanyl monotherapy.

Keyword

Intravenous propacetamol; fentanyl; opioid-sparing effect; numerical rating scale; patient controlled analgesia