Comparison between pre-emptive oral tramadol and tapentadol for attenuation of catheter-related bladder discomfort and surgical stress response in patients undergoing transurethral resection of prostate: A prospective, randomised, double-blind trial

Background and Aims:

Surgical interventions involving urinary catheterisation often lead to catheter-related bladder discomfort (CRBD). With a very high incidence rate of 47%–90%, CRBD often leads to a distressing and painful recovery after surgery. Although many opioids have been used for the treatment of CRBD, the search for the best is still going on. This study investigated the efficacy and tolerability of oral tapentadol and tramadol on postoperative CRBD.

Methods:

This was a prospective, randomised double-blind study. 100 patients, undergoing transurethral resection of the prostate were randomly assigned into two groups to receive tramadol 100 mg (Group A) or tapentadol 50 mg (Group B) orally 1 h before surgery. CRBD was evaluated on a 4-point severity scale in the post-operative area at 0, 0.5, 1, 2, 3, 4, 5 and 6 h. Pain and adverse effects were assessed postoperatively. Serum cortisol levels before and after the procedure were noted. Statistical analysis was done with the analysis of variance, t test.

Results:

Postoperative CRBD, 2 h after surgery was significantly reduced in group B than group A (P = 0.012). Cortisol levels, postoperatively were significantly lower in Group B (113 ± 65.45) (P = 0.001) than group A (162.64 ± 118.84 ng/dL). Dry mouth was seen in four, nausea in eight and sedation in six patients in group A while none in group B. 14 patients in Group A and one patient in Group B needed intravenous paracetamol (P = 0.000).

Conclusions:

Premedication with tapentadol was more effective in reducing CRBD and pain postoperatively. The surgical stress response and side effects were significantly reduced with tapentadol.

Comparison of tapentadol with tramadol for analgesia after cardiac surgery

Background:

Tapentadol is a relatively new analgesic. We decided to compare it with tramadol for their various effects after cardiac surgery.

Setting:

A study in a tertiary care hospital.

Materials and Methods:

Sixty adults undergoing cardiac surgery were divided into 2 groups of 30 each by computerized random allotment (Group X = tapentadol 50 mg oral and Group Y = tramadol 100 mg oral). Informed Consent and Institutional Ethics Committee approval were obtained. The patients were given either drug X or drug Y after extubation in this single blinded study, wherein the data collectors and analyzers were blinded to the study. All patients received oral paracetamol qds and either drug X or drug Y tds. The pain score was noted on a Visual Analog Scale before each drug dose, 3 h later and on coughing. Heart rate, respiratory rate, and blood pressure were recorded before the drug dose and 3 h later. Postoperative nausea or vomiting (PONV), temperature, and modified Glasgow Coma Scale readings were recorded. The above readings were obtained for 6 doses (up to 48 h after extubation).

Statistics:

t-test, Pearson Chi-square test, Fisher exact test, and Mantel–Haenszel test were used for statistics.

Results:

Tapentadol group patients had significantly better analgesia 3 h after the drug and “on coughing” than tramadol group. The difference in their effects on blood creatinine levels, temperature, hemodynamics, oxygen saturation, and respiratory rate were not clinically significant. Tapentadol produced lesser drowsiness and lesser vomiting than tramadol.

Conclusions:

Tapentadol, due to its norepinephrine reuptake inhibition properties, in addition to mu agonist, is a better analgesic than tramadol and has lesser PONV.

Clinical value of tapentadol extended-release in painful diabetic peripheral neuropathy

Painful diabetic peripheral neuropathy is difficult to treat, partially because the underlying mechanism of pain is not fully understood. Various treatment guidelines recommend first-line agents, such as α2-δ ligands, serotonin-norepinephrine reuptake inhibitors, and tricyclic antidepressants but combination therapy of alternative agents including opiates is often warranted. Tapentadol extended-release has a novel dual mechanism of action; it is both a mu-opioid receptor agonist and a norephinephrine reuptake inhibitor. It has been in the spotlight since it was FDA-approved specifically for the treatment of painful diabetic peripheral neuropathy in 2012. Previous reviews of tapentadol have focused on chronic pain. The purpose of this review article is to assess the efficacy and safety of tapentadol extended-release in adult populations with painful diabetic peripheral neuropathy and provide guidance for formulary decisions.