PERI-OPERATIVE
Intranasal Tapentadol Versus Intravenous Paracetamol for Postoperative Analgesia in Lower Limb Orthopaedic Surgeries Under Spinal Anaesthesia: A Single Blind RCT.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2024;12(22):22 Clin J Pain . 2024 Aug 1;40(8):463-468.What this means for my practice?
Intranasal tapentadol is superior to intravenous paracetamol for postoperative pain management in lower limb orthopedic surgeries, offering better pain control and reduced need for rescue analgesia. Clinicians should consider its ease of administration and hemodynamic stability when selecting analgesics. However, the study's small sample size and limited adverse effect data are notable limitations.
Study Summary
Seventy-four patients undergoing lower limb orthopedic surgeries under spinal anesthesia were randomized to receive either intranasal tapentadol (44.5 mg, n=37) or intravenous paracetamol (1 g, n=37) every 6 hours for 72 hours, starting 3 hours after surgery. The primary outcome was pain intensity measured by the Visual Analog Scale (VAS). Secondary outcomes included systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and the need for rescue analgesia. Outcomes were assessed at multiple time points up to 72 hours post-intervention. Overall, the study revealed that intranasal tapentadol resulted in significantly lower pain scores compared to intravenous paracetamol. Additionally, patients in the tapentadol group required no rescue analgesia and exhibited favorable hemodynamic parameters.
Why was this study needed now?
Postoperative pain management remains critical in lower limb orthopedic surgeries. Intranasal tapentadol, a novel centrally acting analgesic with dual mechanisms, offers ease of administration and a favorable safety profile compared to intravenous paracetamol, a commonly used analgesic with predictable pharmacokinetics but requiring complex administration. Despite their individual benefits, no direct comparison of these two agents had been made for postoperative pain relief. This study addresses a significant knowledge gap and seeks to determine the superiority of one approach over the other.
What was the principal research question?
In patients undergoing lower limb orthopedic surgeries under spinal anesthesia, does intranasal tapentadol result in better postoperative analgesia compared to intravenous paracetamol over a 72-hour period?
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