Clinical evaluation of fentanyl transdermal patch VS intercostal nerve block in early post thoracotomy pain

ABSTRACT

Introduction: Thoracotomy pain interferes with respiratory movements leading to depression of the respiratory function in early postopertative peroid. To evaluate the efficacy of Fentanyl patch VS Intercostal nerve block to control pain and improve early postoperative respiratory function.' Material and 40 patients were submitted to cardiac operation through a thoracotomy incision, and were extubated within 2 hours after operation, were divided into 2 equal groups. Group [A] received Fentanyl transdermal patch 50 micro g/h for 24 hours, and group [B] received intercostal nerve block at the level of thoracotomy at the end of the operation, using 10 ml of lignocaine 2% +10 ml of Bupivacaine 0.5% both groups received Meperidine intravenously on demanded according to the visual analogue scale readings. [VAS > 30] group [A] had a significantly [p < 0.05] lower heart rate than group [B]. During the first 6 hours 02 saturation in blood sample were significantly better in group [B] than [A] [p < 0.05] while in the following 12 hours group [A] had a better 02 saturation than [B] [p < 0.05]. Measured pain scores with the VAS were significantly higher after the first 6 hours in group [B] than [A] [p < 0.05]. The need for Meperidine was significantly higher in group [B] than [A] after the first 6 hours. Nausea and vomiting incidence difference was insignificant. Fentanyl transdermal patch is proved to be a better modality for pain relief and improving respiratory function over the first 24 hours