下顎第三大臼歯転子部手術におけるフェンタニル経皮パッチの有効性-比較研究

Efficacy of Fentanyl Transdermal Patch in Impacted Mandibular Third Molar Surgery-A Comparative Study.

抄録

はじめに:

下顎第3大臼歯の外科的抜歯は、最も頻繁に行われる口腔外科手術のひとつであり、術後の疼痛、腫脹、顎関節症を伴うことが多い。疼痛管理の一般的な進歩にもかかわらず、下顎第三大臼歯の抜歯後の中等度から重度の急性術後痛は依然として問題である。フェンタニルは、癌性疼痛や術後疼痛などの重篤な慢性疼痛の治療に極めて有効な薬剤であり、患者の痛みに対する耐性を高める作用がある。フェンタニル経皮吸収システム（FTS）は、強力な短時間作用型スケジュールIIオピエートであるフェンタニルを高濃度に含有する長方形の経皮吸収パッチである。本研究では、下顎第3大臼歯転子部手術後の術後疼痛管理に対する経皮フェンタニルの有効性を評価する。

INTRODUCTION: Removal of mandibular third molars surgically is one of the most frequently performed oral surgical procedures which are often accompanied with post-operative pain, swelling and trismus. Despite general progress in pain management, moderate to severe acute post-operative pain after removal of lower third molars remains a problem. Fentanyl is an extremely effective drug in the treatment of severe chronic pain such as cancer pain and post-operative pains which acts by increasing patient's tolerance to pain. Fentanyl Transdermal System (FTS) is a rectangular transdermal patch which contains high concentration of fentanyl, a potent short-acting Schedule II opiate. In this study the efficacy of transdermal fentanyl for management of post-operative pain after impacted mandibular 3rd molar surgery is evaluated.

方法:

無症候性下顎第3大臼歯内反症患者20名（18～40歳）をA群とB群に分け、局所麻酔にて手術を行った。A群には50μgのFTSを、B群にはプラセボパッチを貼付した。

METHODS: 20 patients within the age group of 18-40 years with asymptomatic impacted mandibular third molars were equally divided into 2 groups as group A & group B which underwent surgery in Local Anaesthesia. In every patient one side belonged to group A and other side belonged to group B. 50 μg FTS was applied in group A while placebo patch was applied in group B.

結果:

VASとVRSで評価した平均疼痛強度スコアの点で、A群の患者はB群より有意に良好であり、術後のレスキュー鎮痛薬の必要性も最小限であった。

RESULTS: Patients in group A performed significantly better than group B in terms of mean pain intensity scores assessed by VAS and VRS along with minimum need of post-operative rescue analgesics.

結論:

FTSは有意に良好な疼痛緩和をもたらし、無痛時間が長く、術後の鎮痛薬消費量が少ないことが判明した。

CONCLUSION: It was found that FTS resulted in significantly better pain relief, longer pain-free intervals, and lesser post-operative analgesic consumption.