Dear Editor,
We have read with great interest the article by Thakur et al. 2022 in December issue of this journal [1]. The authors have conducted a split-mouth randomized control design in 20 patients within the age group of 18–40 years who required bilateral third molar extraction. The results of this study suggested that 50 μg fentanyl transdermal patch resulted in significantly better pain relief, longer pain-free intervals, and lesser post-operative analgesic consumption [1]. Todorovic et al. 2016 conducted the exact similar randomized split-mouth study in which 17 patients required bilateral third molar extractions. This study used a fentanyl transdermal patch of lower dosage 25 μg, which is found to be associated with better pain relief and lower analgesic consumption than placebo patch [2].
Although fentanyl transdermal patch is found to be very effective in relieving post-operative pain after surgical removal of third molar, there are certain considerations that we feel should be discussed before using fentanyl transdermal patches. Adverse effects due to the usage of fentanyl transdermal patches can range from nausea, headache, pyrexia, coma, respiratory depression, to death also [3–7]. Surface characteristics in the skin determine the drug plasma bioavailability. Elevation of skin temperature or increase in the external temperature can lead to enhanced absorption of transdermally applied fentanyl due to vasodilatation and increased drug release due to aggravated solubility [8]. Broken skin and eczematous skin also can increase the toxicity of fentanyl patches [4]. Symptoms of fentanyl transdermal patch overdosage can be respiratory depression and constricted pupils similar to that of opioid toxicity [9]. Fentanyl transdermal overdosage is managed with focus primarily on ventilatory support (bag valve mask ventilation, endotracheal intubation or Laryngeal mask airway) and oxygenation. Naloxone (0.4–2 mg) dose effectively antagonizes overdosage in mildly poisoned, non-vomiting, opioid-tolerant patients with adequate spontaneous ventilation. Failure to arouse with an appropriately titrated dose of naloxone may signal the presence of cerebral hypoxia. In such cases, higher than normal doses of naloxone may be required [8]. Non-opioid such as ketoprofen or diclofenac transdermal patches can also be considered as alternatives [10].
Declarations
Conflict of interest
All authors declare that they have no conflict of interest.
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References
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