Comparison Between Transdermal Buprenorphine and Transdermal Fentanyl for Postoperative Pain Relief After Elective Open Cholecystectomy

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Background: Transdermal opioid delivery provides sustained analgesia without repeated parenteral administration. Buprenorphine and fentanyl are potent lipophilic opioids suitable for transdermal administration, but comparative evidence following open cholecystectomy remains limited. Aim: To compare the analgesic efficacy and safety of transdermal buprenorphine and transdermal fentanyl for postoperative pain relief following elective open cholecystectomy. Materials and Methods: This prospective comparative observational study included 80 ASA physical status I–II patients aged 20–60 years undergoing elective open cholecystectomy under general anaesthesia. Forty patients received a transdermal buprenorphine patch (5 ?g/hour), and 40 received a transdermal fentanyl patch (25 ?g/hour). Postoperative pain using the Visual Analogue Scale (VAS), rescue analgesic requirement, haemodynamic parameters, Ramsay sedation scores and adverse events were assessed for 72 hours. A p-value <0.05 was considered statistically significant. Results: VAS scores were comparable between groups during the first 6 postoperative hours. From 12 hours onward, fentanyl produced significantly lower pain scores (12 hours: 4.00 ± 0.00 vs 4.15 ± 0.36, p=0.012), with highly significant differences at 24, 48 and 72 hours (all p<0.001). At 12 hours, rescue analgesia was required by 30% of patients receiving buprenorphine compared with none receiving fentanyl (p<0.001). Ramsay sedation scores were significantly higher with buprenorphine on Days 2 and 3 (p<0.001). Nausea occurred in 22.5% and 7.5% of the buprenorphine and fentanyl groups, respectively (p=0.1175). No respiratory depression, hypotension, bradycardia or skin rash was observed. Conclusion: Both transdermal opioids provided postoperative analgesia, but within the doses evaluated, transdermal fentanyl 25 ?g/hour was associated with better sustained postoperative pain control and lower rescue analgesic requirement than transdermal buprenorphine 5 ?g/hour, without an increase in serious adverse effects during the 72-hour observation period. Keywords: Transdermal buprenorphine; transdermal fentanyl; postoperative analgesia; open cholecystectomy; Visual Analogue Scale; rescue analgesia.

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