The Effectiveness of Transdermal Opioid in the Management Multiple Rib Fractures: Randomized Clinical Trial

Background: The most commonly observed pathology in chest traumas is rib fracture, and the most important clinical symptom is severe pain.Aims: To investigate the effectiveness of intramuscular opioid (IMO), intravenous patient-controlled analgesia (IVPCA) and the Fentanyl transdermaltherapeutic system (TTS) in the management of rib fracture pain.Study Design: Prospective randomized clinical trial.Methods: In our prospective and randomised study, we included 45 patients with a diagnosis of multiple rib fractures. There were three groups andintercostal nerve blockage (ICB) in the first day and oral paracetamol for five days was administered to each group as standard. In Group IMO (n=15),4x40 mg pethidine HCl was administered to the patients, while in Group IVPCA (n=15) this was 5 μg/mL continuous intravenous fentanyl and was 50 μgfentanyl TTS in Group TTS (n=15). The demographics, injury data and vital signs of the patients were recorded. Pain was scored using Visual AnalogueScale (VAS). The pain during lying down (VAS_l) and mobilisation (VAS_m) was detected.Results: There were no differences between the three groups regarding age, sex, the trauma pattern, the number and distribution of costal fracturelocalisations, the presence of additional pathology, complications, thoracal catheter and the duration of thoracal catheter. No significant differencebetween the groups regarding systolic and diastolic arterial tension, number of breaths and beats in a minute was observed (p 0.05). We observedan improvement in the mean VAS score after treatment in all three groups. The mean VASl score significantly decreased after treatment in each group(p 0.05). The mean VAS_l and VAS_m scores measured on the 1st, 2nd, 3rd, 4th and 5th days were found to be higher in Group IMO than in Groups IVPCA andTTS; however, these differences were not statistically significant (p 0.05).Conclusion: In the analgesia of patients with multiple rib fractures, TTS administration with ICB showed similar effectiveness with IVPCA administrationwith ICB. In the management of pain due to multiple rib fractures, TTS administration is a safe, non-invasive and effective procedure.