Title: Tu1409 Efficacy of Transdermal Fentanyl for Pain in ESD Patient
Abstract: With the recent widespread use of endoscopic submucosal dissection (ESD) as a therapeutic technique, the epigastric pain management of ESD patient after the procedure have been considered as important issues. Several synthetic opioids have been used for pain control after ESD, yet currently there are no studies which have compared their efficacy and safety. Sometimes, repetitive administration of synthetic opioid. On the other hand, transdermal fentanyl patch can provides long-term continuous pain-management. This study investigates the usefulness and safety of the fentanyl patch for pain relief in ESD patients. The patients with gastric epithelial neoplasia scheduled to undergo ESD were randomly assigned to a fentanyl patch-receiving test group (TDF group) and a placebo control group (P group) prospectively. At the evening before the ESD procedure, the TDF group received a 12.5 mcg/h fentanyl patch, whereas the P group received a placebo patch. The patients and examiners were blinded. An additional IV 25 mg of pethidine was administered at the event of pain development, and a numerical rating scale (NSR) was used to evaluate pre- and post-procedural pain on a scale of 0 to 10. A total of 104 patients enrolled in the study. 50 patients received the fentanyl patch and 54 patients received the placebo patch. There were no differences in age, height, body weight and gastric lesion location, size and pathology. The TDF group showed significantly less pain right after the procedure(median, 5.0 vs 3.0, p=0.030). The maximal pain score during 24 hours(6.0 vs 3.0, p=0.038), and one-day after the procedure(3.0 vs 1.0, p<0.001) were also lower than placebo group. In addition, the TDF group required significantly less pethidine dosage for pain relieve. Both test and control groups showed minor side effects such as anorexia and nausea, but there were no serious side effects. The ESD procedure can cause considerable epigastric pain and therefore requires vigilant pain control. The Transdermal fentanyl patch is effective, convenient, safe to control epigastic pain after ESD.