D'Amato Tiziana, Martorelli Federica, Fenocchio Giorgia, Simili Vincenzo, Kon Elizaveta, Di Matteo Berardo, Scardino Marco
Department of Anesthesia, Humanitas Research Hospital, Rozzano, Milan, Italy.
Department of Biomedical Sciences, Humanitas University, Via Manzoni 113, 20089, Rozzano, Milan, Italy.
J Exp Orthop. 2019 Jul 29;6(1):36. doi: 10.1186/s40634-019-0204-6.
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.
Single-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.
106 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).
Results 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.
近年来，关节置换手术已逐渐朝着快速康复模式发展，术后立即进行早期康复被视为功能最佳恢复的基础：本研究的目的是描述在接受全髋关节置换手术并接受曲马多或羟考酮/纳洛酮联合酮洛芬治疗的患者围手术期疼痛管理中的疗效。
对因全髋关节置换而出现中重度疼痛的患者进行单中心回顾性研究。患者接受曲马多（术后每日两次，每次100mg - 治疗组）或羟考酮/纳洛酮（术后10mg/5mg - 对照组）加每日两次100mg酮洛芬。必要时提供补充镇痛（对乙酰氨基酚1g或吗啡0.1mg/kg皮下注射）。术后4天每天评估静息时疼痛和运动时疼痛，之后患者通常出院。报告并比较两组的所有不良事件。
曲马多组分析了106例患者，并与105例接受羟考酮/纳洛酮治疗的患者进行比较。在所有随访时间，曲马多组的静息和运动时疼痛强度均显著更低（p < 0.001）。在整个T1 - T4期间，与对照组相比，曲马多组需要补充镇痛的患者明显更少。同样，在副作用方面，对照组术后恶心、呕吐、瘙痒和便秘的发生率显著更高（所有情况p < 0.001）。
本研究结果支持在骨科大手术中使用曲马多联合酮洛芬来管理中重度疼痛，因为它在降低疼痛强度方面有效，且耐受性良好。
