Bakeer, A.H., & Abdallah, N.M. (2017). Transdermal fentanyl as an adjuvant to paravertebral block for pain control after breast cancer surgery: A randomized, double-blind controlled trial. Saudi Journal of Anaesthesia, 11, 384–389.

Aim of the study was to investigate the effect of transdermal fentanyl (TDF) as an adjuvant to paravertebral block (PVB) for pain control after breast cancer surgery.

Trial included 50 females scheduled for mastectomy that were randomly allocated into one of two equal groups. The transdermal (TDF group) used transdermal fentanyl patches (TFPs) 25 mcg per hour applied 10 hours preoperative, then PVB with 20 ml of bupivacaine 0.25% was done before induction of general anesthesia. The PVB group used placebo patches in addition to PVB. Postoperative pain was assessed with a visual analog scale (VAS) score up to 48 hours. IV morphine 0.1 mg/kg was given when the VAS is ≥ 3 or on patient request. There was no significant difference between the two groups regarding age, weight, ASA class, and duration of anesthesia and surgery. The primary outcome measures were the time to first request for analgesia and the total analgesic consumption in the first 48 hours.

• N: 50  
• AGE: 49.8 (SD = 3.5) 
• FEMALES: 100%
• CURRENT TREATMENT: Not applicable
• KEY DISEASE CHARACTERISTICS: Breast cancer

• SITE: Single site   
• SETTING TYPE: Inpatient    
• LOCATION: Egypt

PHASE OF CARE: Active anti-tumor treatment

Randomized, double-blind trial

Time to first request for analgesia and total analgesic consumption in the first 48 hours were analyzed. Group differences were compared using the independent samples Student's t-test or Mann-Whitney for numerical variables. Chi-square test was used to examine the relationship between qualitative variables. Two-way analysis of variance was used to test the interaction between the two groups' hemodynamic variables. Observer’s Assessment of Alertness/Sedation (OAA/S) and the visual analog scale (VAS) were also used.

The VAS score was significantly lower in TDF group than PVB group from 30 minutes postoperatively up to 24 hours. The time to the first request of additional analgesia was significantly longer in the TDF group (p < 0.001). The total dose of morphine consumption in 48 hours was significantly lower in TDF group (p = 0.039)

The use of fentanyl patches preoperatively and BVP appears to reduce the amount of morphine requested within the first 48 hours postoperatively for breast surgery and correlate with lower VAS scores.

Small sample (< 100)

Preemptive analgesia, if TFP is applied before surgery, it can be used to relieve postoperative pain.