Role of preemptive tapentadol in reduction of postoperative analgesic requirements after laparoscopic cholecystectomy

Abstract

Background and Aims:Poorly managed acute postoperative pain may result in prolonged morbidity. Various pharmacotherapies have targeted this, but research on an ideal preemptive analgesic continues, taking into account drug-related side effects. Considering the better tolerability profile of tapentadol, we assessed its role as a preemptive analgesic in the reduction of postoperative analgesic requirements, after laparoscopic cholecystectomy.Material and Methods:In a prospective-double-blinded fashion, sixty patients posted for above surgery, were randomized to receive tablet tapentadol 75 mg (Group A) or starch tablets (Group B) orally, an hour before induction of general anesthesia. Perioperative analgesic requirement, time to first analgesia, pain, and sedation score were compared for first 24 h during the postoperative period and analyzed by one-way analysis of variance test. A P < 0.05 was considered significant.Results:Sixty patients were analyzed. The perioperative analgesic requirement was significantly lower in Group A. Verbal numerical score was significantly lower in Group A at the time point, immediately after shifting the patient to the postanesthesia care unit. Ramsay sedation scores were similar between the groups. No major side effects were observed except for nausea and vomiting in 26 cases (10 in Group A, 16 in Group B).Conclusion:Single preemptive oral dose of tapentadol (75 mg) is effective in reducing perioperative analgesic requirements and acute postoperative pain, without added side effects. It could be an appropriate preemptive analgesic, subjected to future trials concentrating upon its dose-response effects.

Postoperative pain management in the postanesthesia care unit: an update

“… 42 Single dose of tapentadol administrated an hour before general anesthesia induction was effective in reducing perioperative analgesic requirements and pain in the PACU without additional side effects. 43 Despite its improved gastrointestinal tolerability, the oral route of tapentadol may limit its usage in the PACU, while preemptive application can be an alternative with cautions in patients who have taken monoamine oxidase inhibitors. 44 …”

Preemptive analgesia with tapentadol in inguinal surgery; a randomized controlled trial

“…This time was longer compared to a study that used tapentadol 75 mg as a preemptive analgesic, prolonged the mean time required for the first rescue analgesic by 96 min in laparoscopic cholecystectomy patients. 9 Therefore, we found that increasing the dose of tapentadol prolongs the duration of analgesia with a similar side effect profile. Some studies showed hyperalgesia with the use of tapentadol, 13 which was not observed in our study.…”

“…We used tapentadol as a preemptive analgesic to evaluate its effect on acute postoperative pain, in contrast to other studies done on chronic pain. 8 Opioids are considered to be more effective in dull aching visceral pain, tapentadol has been shown to be effective in laparoscopic surgeries, 9 bunionectomy and abdominal hysterectomy. 10 We used tapentadol as a preemptive analgesic for inguinal surgeries, which have moderate postoperative pain.…”

Tapentadol versus oxycodone analgesia and side effects after laparoscopic hysterectomy

“…Tapentadol has been shown to be effective for acute and chronic nociceptive, neuropathic or cancer-related pain, 7,8 but there is a lack of broad-based evidence for tapentadol in the postsurgical setting 9 . To our knowledge, the published studies on analgesic effects from tapentadol are mainly industry-funded studies on orthopaedic and dental patients, 10–12 and few are related to procedures with major components of visceral pain, such as laparoscopy 13,14 . A review of tapentadol studies in the postoperative setting indicated less nausea, vomiting, constipation and pruritus compared with oxycodone but no difference in somnolence, headache or dizziness 10 .…”

“…9 To our knowledge, the published studies on analgesic effects from tapentadol are mainly industry-funded studies on orthopaedic and dental patients, [10][11][12] and few are related to procedures with major components of visceral pain, such as laparoscopy. 13,14 A review of tapentadol studies in the postoperative setting indicated less nausea, vomiting, constipation and pruritus compared with oxycodone but no difference in somnolence, headache or dizziness. 10 Studies on respiratory depression from tapentadol in any setting are sparse.…”