Continuous Epidural versus Transdermal Fentanyl for Postoperative Analgesia after Total Abdominal Hysterectomy: A Randomised Comparative Study

Background: This study evaluated and compared the effectiveness and safety profiles of fentanyl administered through a transdermal patch versus continuous epidural infusion for postoperative pain control in patients who had undergone total abdominal hysterectomy (TAH). Material and Methods: This was a prospective observational comparative randomized study carried out among 42 ASA I–II patients of age 18 to 60 years who underwent TAH at a tertiary hospital in South India (June 2021–November 2022). Patients were randomly allocated into Group E (epidural fentanyl infusion) and Group T (transdermal fentanyl patch). Hemodynamic stability and pain were assessed 2–24 hours postoperatively. Ramsay and Bromage scores were used for assessing sedation and motor block. SPSS v25 was used for analyzing data, and p < 0.05 was considered significant. Results: There were significantly lower VAS scores in Group E at 6, 8, and 12 hours (p = 0.019, <0.0001, <0.0001, respectively), indicating better analgesia. Epidural drug consumption was higher in Group T (123.67 ± 4.41 mL vs. 113.81 ± 3.63 mL, p < 0.0001). Rescue analgesic requirement and incidence of nausea or vomiting were similar across groups. Hemodynamically, patients were stable in both groups postoperatively. Ramsay and Bromage scores were comparable, showing no excessive sedation or motor block. Conclusion: Both routes provided effective analgesia, but continuous epidural fentanyl yielded superior pain control, reduced drug requirement, and higher patient satisfaction, making it the preferred postoperative analgesic technique following TAH.

Keywords: analgesia, epidural, fentanyl, hysterectomy, nausea, Visual analogue scale, vomiting.