Acceso usuarios
Teruel, España
El dolor irruptivo postoperatorio es un dolor agudo, principalmente nociceptivo, predecible en cuanto a duración (1 a 7 días). El citrato de fentanilo oral transmucosa (CFOT) tiene una rápida absorción por la mucosa oral, dicho mecanismo, al ser transcelular (sustancia lipofílica, no ionizada), permite mayor absorción por esta vía que, por ejemplo, la morfina que es hidrofílica e ionizada.
Se realiza un estudio cuasiexperimental: Ensayo antes-después de eficacia analgésica tras administración de opioide de rescate, en 30 pacientes intervenidos de PTR (Enero, Febrero y Marzo). Se alterna un paciente con pauta de Cloruro mórfico subcutáneo (1 ampolla), otro con pauta de Citrato de fentanilo oral transmucosa (1 comprimido de 100µg). El 90% previo a la cirugía necesitaba una pauta analgésica de 2º escalón de la O.M.S, se siguió el nivel de dolor postoperatorio durante 48 horas, recogiendo nivel de dolor cada 8h y antes-después de administrar rescate con ambos opiáceos.
El estudio registró existencia de diferencias significativas en cuanto a eficacia de control analgésico antes-después de administración del opioide de rescate a favor del citrato de fentanilo sublingual, p=0,010 (p≤0,05). La evaluación de efectos secundarios demostró buena tolerancia de ambos fármacos y el descanso nocturno fue similar en ambos grupos.
El CFOT puede utilizarse como analgésico de rescate por su rapidez y seguridad, para el tratamiento del dolor irruptivo asociado a intervenciones quirúrgicas. Numerosos trabajos avalan su indicación para el tratamiento del dolor irruptivo oncológico, sin embargo, su uso aún no está suficientemente extendido en el entorno postoperatorio.
Breakthrough pain is a sharp pain that occurs after surgery, mainly nociceptive, predictable in duration (1 to 7 days). The oral transmucosal fentanyl citrate (OTFC) is quickly absorbed through the oral mucosa, this mechanism of transmucosal absorption is transcellular and permits a better transit of lipophilic non-ionized substances, such as OFTC, than that of the morphine (hydrophilic ionized).
A quasi-experiment study was performed to evaluate the analgesic efficacy after the administration of two opioid drugs as rescue analgesia. 30 patients underwent surgery for total knee replacement between January and March 2012. When rescue analgesics were needed, patients were randomized and 50% of them were treated with subcutaneous morphine (1 amp), while oral transmucosal fentanyl citrate (100 µg) was used in the remaining. 90% of them had needed a 2nd step of the WHO analgesic ladder before surgery. The intensity of pain was recorded by means of the Visual Analogic Scale (VAS) every 8 hours during the first two days postoperatively, before and after the administration of the opioids.
From the analysis of the data, significant differences in the efficacy of pain control were found between the two opioids. Sublingual fentanyl citrate showed a higher analgesic effect (p = 0.010). The evaluation of side effects showed good tolerability of both drugs and the sleeping patterns evaluated by the modified MOSS scale were similar in both groups.
OTFC can be used as a fast and safe rescue analgesic for the treatment of breakthrough pain associated with knee surgery. Its features are an easy and comfortable administration and a great tolerability by patients. Several studies support its use for the treatment of breakthrough cancer pain, nevertheless its use has not been yet widely developed in the postoperative environment.
