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Comparison of the efficacy of IV-PCA between Fentanyl and Morphine after burn necrosis excision and skin graft surgery
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Abstract
Objectives: To compare the postoperative analgesic efficacy of IV-PCA Fentanyl with Morphine in patients undergoing burn necrosis excision and skin graft surgery.
Subjects and methods: A comparative prospective study was conducted in 70 burn cases divided into 2 groups with 35 cases in each group having indications for burn necrosis excision and skin graft surgery. After the surgery, they were given IV-PCA Fentanyl (group F) or morphine (group M) for postoperative pain control. When the patients were painful (VAS ≥ 4), analgesics were titrated as following: In the group F, 0.025mg Fentanyl was intravenously injected and repeated every 5min until VAS < 4, then IV-PCA was started. The total titration dose of Fentanyl was below 0.1mg.
In group M, 1mg Morphine was intravenously injected and repeated every 5 minutes until VAS < 4, then IV-PCA was started. The total titration dose of Morphine was below 10mg. IV-PCA setting were bolus 1ml (Fentanyl 0.025mg or Morphine 1mg), lockout time 10min, basal continuous infusion 1ml/h (Fentanyl 0.025mg/h or Morphine 1mg/h), maximum dosage 15ml/4h (Fentanyl 0.375mg/4h or Morphine 15mg/4h).
Results: In group F, the minimum and maximum of the visual analog scores (VAS) at rest after started IV-PCA were 2.03 ± 0.17 and 2.23 ± 0.64, respectively. In group M, minimum and maximum VAS at rest after started IV-PCA were 2.03 ± 0.2 and 2.14 ± 0.4, respectively. In group F, minimum and maximum VAS on movement after started IV-PCA were 3.03 ± 0.17 and 3.14 ± 0.49, respectively. In group M, minimum and maximum VAS on movement after started IV-PCA were 3.03 ± 0.2 and 3.23 ± 0.6, respectively. VAS at rest and on movement were statistically insignificant differences between the two groups (p > 0.05). The proportion of unsatisfied patients in group F was statistically significantly lower than that in group M (5.7% versus 20%) (p < 0.05).
Conclusions: The analgesic efficacy of IV-PCA between Fentanyl and Morphine after burn necrosis excision and skin graft surgery was similar but the only proportion of satisfied patients in the IV-PCA Fentanyl group was higher than that in the IV-PCA Morphine group.
Article Details
Keywords
Fentanyl, Morphine, IV-PCA, burn necrosis excision and skin graft
References
2. Cornelia Griggs, Jeremy Goverman, Edward Bittner, and Benjamin Levi. Sedation and Pain Management in Burn Patients. Clin Plast Surg 2017;44(3):535-540.
3. Jeffrey A. Grass. Patient-controlled Analgesia. Anesth & Analg 2005;101(5): 44-61.
4. Lavrentieva A., Depetris N., Rodini I. Analgesia, sedation and arousal status in burn patients: the gap between recommendations and current practices. Annals of Burns and Fire Disasters 2017;30(2):135-142
5. Smita Prakash, Tazeen Fatima, and Mridula Pawar. Patient-Controlled Analgesia with Fentanyl for Burn Dressing Changes. Anesth Analg 2004;99:552-5
6. Siamak Rimaz, Cyrus Emir Alavi, Abbas Sedighinejad, Mohammad Tolouie, Sharareh Kavoosi, Leila Kouchakinejad. Effect of Gabapentin on Morphine consumption and Pain after Surgical Debridement of Burn Wounds: A Double-Blind Randomized Clinical Trial Study. Arch Trauma Res. 2012;1(1):38-43
7. In-Suk Kwak et al. The Effect of Weight-Compensated Intravenous Patient-Controlled Analgesia in Burns. J Korean Burn Soc 2013;16:12-16
8. Ying-Chun Lin, Chien-Chung Huang, Nuan-Yen Su, Chia-Lin Lee, Hsuan-Chih Lao, Chia-Shiang Lin, Chien-Chuan Chen. Patient-controlled analgesia for background pain of major burn injury. Journal of the Formosan Medical Association 2019;118:299-304
9. Yukitoshi Niiyama, Nobuyoshi Matsuoka, Reona Sugimoto and Michiaki Yamakage. Efficacy of Intravenous Patient-Controlled Analgesia (IV-PCA) using Fentanyl compared with IV-PCA using morphine after abdominal surgery: a prospective randomized study. J Anesth Clin Res 2016;7(1):1-5
10. Paul R. Howell, David R. Gambling, Timothy Pavy, Graham McMorland, M.Joane Douglas. Patient-controlled analgesia following Caesarean section under general anaesthesia: a comparison of fentanyl with morphine. Can J Anaesth 1994;42(1):41-45
11. Eman M.Nada, Abdulmajeed Alabdulkareem. Morphine versus fentanyl patient-controlled analgesia for postoperative pain control in major hepatic resection surgeries including living liver donors: A retrospective study. Saudi J Anaesth 2018;12:250-5