Tapentadol vs oxycodone/naloxone in the management of pain after total hip arthroplasty in the fast track setting: an observational study

Tiziana D’Amato,Elizaveta Kon,Vincenzo Simili,Giorgia Fenocchio,Berardo Di Matteo,Federica Martorelli,Marco Scardino

doi:10.1186/s40634-019-0204-6

Tiziana D’Amato, Elizaveta Kon + Show 5 more

Open Access

https://doi.org/10.1186/s40634-019-0204-6

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Abstract

BackgroundIn recent years, joint replacement surgery has gradually progressed towards the fast-track model, and early rehabilitation immediately after surgery is regarded fundamental for optimal recovery of function: the aim of the present study is to describe the efficacy in perioperative management of pain in patients undergoing total hip replacement surgery and treated with tapentadol or oxycodone/naloxone in combination with ketoprofene.MethodsSingle-center retrospective study on patients with moderate-severe pain, referred to total hip replacement. Patients received either tapentadol (100 mg/twice-daily post-surgery – treatment group) or oxycodone/naloxone (10 mg/5 mg post-surgery – control group) plus ketoprofen 100 mg/ twice daily. Supplemental analgesia (paracetamol 1 g or morphine 0,1 mg/kg sc) was provided if needed. Pain at rest and pain during movement were evaluated on a daily basis for 4 days post-op, after which patients were usually discharged. All adverse events were reported and compared between the two groups.Results106 patients were analyzed in the tapentadol group and compared to 105 patients treated with oxycodone/naloxone. Both pain intensity at rest and upon movement were significantly lower in the tapentadol group at all follow-up times (p < 0.001). Throughout T1-T4, supplemental analgesia was needed by significantly less tapentadol patients compared to the control group. Similarly, regarding side effects, a significantly higher occurrence of post-op nausea, vomit, itching and constipation was observed in the control group (p < 0.001 in all cases).ConclusionResults from the present study support the use of tapentadol in combination with ketoprofen for the management of moderate-severe pain in the setting of major orthopedic surgery, given its effectiveness in reducing pain intensity, and its satisfactory tolerance.

Highlights

In recent years, joint replacement surgery has gradually progressed towards the fast-track model, and early rehabilitation immediately after surgery is regarded fundamental for optimal recovery of function: the aim of the present study is to describe the efficacy in perioperative management of pain in patients undergoing total hip replacement surgery and treated with tapentadol or oxycodone/naloxone in combination with ketoprofene
In recent years replacement surgery has gradually progressed towards the Scandinavian fast-track model (Rodriguez-Merchan, 2015), which aims to facilitate a quick rehabilitation by ensuring that the patient reaches surgery in clinically and psychologically optimal conditions
Eliciting such a model involves tackling two major issues: (i) the management of moderate-severe chronic pain reported by most patients waiting for orthopedic intervention, and (ii) the need to counteract the onset of collateral effects typical of new opioid-based analgesics as well as other negative stimuli which could affect postoperative rehabilitation. Since these issues apply to most types of orthopedic surgery, they represent a paramount problem in the field of total hip replacement (THR), where early rehabilitation immediately after surgery is fundamental for the optimal recovery of functionality and its associated conditions

Summary

Introduction

Joint replacement surgery has gradually progressed towards the fast-track model, and early rehabilitation immediately after surgery is regarded fundamental for optimal recovery of function: the aim of the present study is to describe the efficacy in perioperative management of pain in patients undergoing total hip replacement surgery and treated with tapentadol or oxycodone/naloxone in combination with ketoprofene. In recent years replacement surgery has gradually progressed towards the Scandinavian fast-track model (Rodriguez-Merchan, 2015), which aims to facilitate a quick rehabilitation by ensuring that the patient reaches surgery in clinically and psychologically optimal conditions Eliciting such a model involves tackling two major issues: (i) the management of moderate-severe chronic pain (generally classified as a “mixed” pain given the coexistence of both nociceptive and neuropathic components) reported by most patients waiting for orthopedic intervention, and (ii) the need to counteract the onset of collateral effects typical of new opioid-based analgesics as well as other negative stimuli which could affect postoperative rehabilitation. Since it does not depend on enzymatic activation, use of the molecule reduces the effect of patient variability in pain management, as is observed with the use of other drugs (Langford, 2016; Schroder et al, 2011; Cowan et al, 2014)

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