Introduction: Spinal fusion (arthrodesis) surgery is associated with mild to severe pain in the post-operative period. Several drugs and analgesia methods can be used for control. The objective of this study was to evaluate the effectiveness of the use of transdermal fentanyl patch, a rarely used potent opioid, and to analyze related side effects, especially respiratory depression.

Methods: Thirty patients, aged 18-70, ASA I-II, subjected to lumbar arthrodesis were randomized in two groups. Half the individuals (15) received a fentanyl patch (12µg/h) that was applied before the operation starts. The second group is the placebo-control group. All patients underwent anesthesia and post-operative analgesia protocol, which was carried out with dipyrone, parecoxib and morphine through a patient controlled analgesia pump (PCA). The patients were blind evaluated every 6 hours over a period of 48 hours through visual analog scale (VAS) and for morphine consumption. Potential side effects such as nausea, vomiting, sedation, pruritus, and respiratory depression were also recorded.

Results: Patients in the fentanyl group presented lower pain scores and lower consumption of morphine. Pain scores were higher in the first 12 hours in the group treated with fentanyl, probably due to slow absorption of transdermal patch. It was found a high incidence of nausea in both groups, probably associated to the use of morphine, despite not having been evident any relation to the dosage. No cases of respiratory depression were observed with the use of transdermal fentanyl.

Conclusions: Transdermal fentanyl patch presents better analgesic effect than the control group, demonstrated by the lower pain scores and lower consumption of morphine. Treatment with transdermal fentanyl 12µg / h did not result in respiratory depression. We recommend that the patch should be applied at least 10h prior to surgery. The treatment is effective for control post-operative pain in spinal fusion surgeries.

Patient Care: The need for care analgesia for postoperative spinal fusion surgery is emphasized and an alternative method, little used, analgesia is demonstrated

Learning Objectives: By the conclusion of this session, participants should be able to: 1. Recognize the necessity to careful analgesia for spinal fusion patients; 2. Understand the opioid mechanism of action for pain relief; 3. Discuss the fentanyl patch efficacy and the time to apply for spine fusion patients.

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