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Comparison of Propacetamol plus Fentanyl and Fentanyl alone with Patient Controlled Analgesia after Total Knee Arthroplasty
Korean J Clin Pharm 2018;28(1):17-23
Published online March 31, 2018
© 2018 Korean College of Clinical Pharmacy.

Minhyung Kim1,2, Hyokeun Jeong2, Sohyun Park3, and Sandy Jeong Rhie1,3,4*

1Graduate School of Converging Clinical & Public Health, Ewha Womans University, Seoul 03760, Republic of Korea
2Veterans Health Service Medical Center, Seoul 05368, Republic of Korea
3Division of Life and Pharmaceutical Sciences Graduate School, Ewha Womans University, Seoul 03760, Republic of Korea
4College of Pharmacy, Ewha Womans University, Seoul 03760, Republic of Korea
Correspondence to: Sandy Jeong Rhie, 1Graduate School of Converging Clinical & Public Health, 3Division of Life and Pharmaceutical Sciences Graduate School and 4College of Pharmacy, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Republic of Korea
Tel: +82-2-3277-3023, Fax: +82-2-3277-2851
E-mail: sandy.rhie@ewha.ac.kr
Received January 18, 2018; Revised March 15, 2018; Accepted March 19, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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.
Keywords : Intravenous propacetamol, fentanyl, opioid-sparing effect, numerical rating scale, patient controlled analgesia


March 2018, 28 (1)
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