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Franco-de la Torre L, Gómez-Sánchez E, Aragon-Martinez OH, Hernández-Gómez A, Franco-González DL, Guzmán-Flores JM, Alonso-Castro AJ, Granados-Soto V, Isiordia-Espinoza MA. Analgesic Efficacy and Safety of Tapentadol Immediate Release in Bunionectomy: A Meta-Analysis. Pharmaceuticals (Basel) 2023; 16:1287. [PMID: 37765095 PMCID: PMC10536393 DOI: 10.3390/ph16091287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/04/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
Abstract
The aim of this systematic review and meta-analysis was to evaluate the analgesic effect of different doses of tapentadol immediate release (IR) and its adverse effects after a bunionectomy. Pubmed, Cochrane, Lilacs, Medline, and Imbiomed were used to identify abstracts of scientific publications related to the keywords of this systematic review (PROSPERO ID CRD42023437295). Moreover, the risk of bias in all included articles was assessed using the Cochrane Collaboration risk of bias tool. Data on the sum of pain intensity, total pain relief, global assessment, and adverse effects were extracted. The statistical method of inverse variance with means difference was used to evaluate the numerical data and the Mantel-Haenszel and Odd Ratio test to analyze the dichotomous data. In addition, the number needed to treat, the number needed to harm, and the 95% confidence intervals were calculated. A qualitative evaluation (n = 2381) was carried out according to the conclusions of the authors. Tapentadol (n = 1772) was more effective in relieving postoperative pain than the placebo (n = 609) after a bunionectomy. In addition, the analgesic efficacy of IR tapentadol (n = 1323) versus the placebo (n = 390) was evaluated in a total of 1713 patients using a global evaluation of the treatments. All three doses of IR tapentadol showed better results compared to the placebo after a bunionectomy. Finally, the adverse effects have a direct relationship with the dose, and the greatest number of adverse effects are most observed with tapentadol IR 100 mg (n = 2381). It is concluded that tapentadol IR (100 mg) leads to the best satisfaction score in this meta-analysis.
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Affiliation(s)
- Lorenzo Franco-de la Torre
- Instituto de Investigación en Ciencias Médicas, Cuerpo Académico Terapéutica y Biología Molecular (UDG-CA-973), Departamento de Clínicas, División de Ciencias Biomédicas, Centro Universitario de los Altos, Universidad de Guadalajara, Tepatitlán de Morelos 47620, Mexico; (L.F.-d.l.T.); (A.H.-G.); (D.L.F.-G.)
| | - Eduardo Gómez-Sánchez
- División de Disciplinas Clínicas, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Mexico;
| | - Othoniel Hugo Aragon-Martinez
- Laboratorio de Productos Naturales, Facultad de Ciencias Químicas, Universidad Autónoma de San Luis Potosí, San Luis Potosí 78210, Mexico;
| | - Adriana Hernández-Gómez
- Instituto de Investigación en Ciencias Médicas, Cuerpo Académico Terapéutica y Biología Molecular (UDG-CA-973), Departamento de Clínicas, División de Ciencias Biomédicas, Centro Universitario de los Altos, Universidad de Guadalajara, Tepatitlán de Morelos 47620, Mexico; (L.F.-d.l.T.); (A.H.-G.); (D.L.F.-G.)
- Departamento de Ciencias de la Salud, División de Ciencias Biomédicas, Centro Universitario de los Altos, Universidad de Guadalajara, Tepatitlán de Morelos 47620, Mexico;
| | - Diana Laura Franco-González
- Instituto de Investigación en Ciencias Médicas, Cuerpo Académico Terapéutica y Biología Molecular (UDG-CA-973), Departamento de Clínicas, División de Ciencias Biomédicas, Centro Universitario de los Altos, Universidad de Guadalajara, Tepatitlán de Morelos 47620, Mexico; (L.F.-d.l.T.); (A.H.-G.); (D.L.F.-G.)
| | - Juan Manuel Guzmán-Flores
- Departamento de Ciencias de la Salud, División de Ciencias Biomédicas, Centro Universitario de los Altos, Universidad de Guadalajara, Tepatitlán de Morelos 47620, Mexico;
| | - Angel Josabad Alonso-Castro
- Departamento de Farmacia, División de Ciencias Naturales y Exactas, Universidad de Guanajuato, Guanajuato 36040, Mexico;
| | - Vinicio Granados-Soto
- Neurobiology of Pain Laboratory, Departamento de Farmacobiología, Cinvestav, South Campus, Mexico City 14330, Mexico;
| | - Mario Alberto Isiordia-Espinoza
- Instituto de Investigación en Ciencias Médicas, Cuerpo Académico Terapéutica y Biología Molecular (UDG-CA-973), Departamento de Clínicas, División de Ciencias Biomédicas, Centro Universitario de los Altos, Universidad de Guadalajara, Tepatitlán de Morelos 47620, Mexico; (L.F.-d.l.T.); (A.H.-G.); (D.L.F.-G.)
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Rooney EM, Odum SM, Hamid N, Irwin TA. Opioid-Free Forefoot Surgery vs Traditional Perioperative Opiate Regimen: A Randomized Controlled Trial. Foot Ankle Int 2023; 44:21-31. [PMID: 36537761 DOI: 10.1177/10711007221140834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND In response to the opioid epidemic, the use of multimodal pain management in orthopaedic surgery is increasing. Efforts to decrease opioid prescribing and opioid consumption among foot and ankle surgical patients are needed. The purpose of this study was to compare the efficacy and adverse events between 2 multimodal pain management pathways for forefoot surgical patients: standard opioid-containing (OC) and opioid-free (OF). METHODS This is a single-center noninferior randomized controlled trial of 51 patients undergoing forefoot surgery allocated to one of 2 perioperative pain management treatments: opioid-free, multimodal (OF, n=27 patients), or traditional opioid-containing (OC, n=24 patients). Patient characteristics, creatine markers, pain (numeric rating scale [NRS]), general health (Veterans Rand 12-Item Health Survey [VR-12]), and depression were measured preoperatively. Postoperatively, pain was measured at 24-hour, 2-week, and 6-week time points. Satisfaction with pain control, complications, and general health were measured at 2 and 6 weeks. RESULTS The OF group is statistically noninferior to the OC group and reported lower median pain scores at 24 hours (2 [IQR 0, 3] vs 6 [IQR 3.5, 7]; p<.0001) and 2 weeks (2 [IQR 1, 4] vs 4 [IQR 0, 3]; p=.018]. By 6 weeks, pain levels were similar between groups. More than 85% of all patients reported satisfaction with pain level at 2 weeks, which increased to >90% at 6 weeks. The VR-12 scores were similar between groups across all time points. At 2 weeks, 8 patients in each group reported constipation. By 6 weeks, all but 2 OC patients reported resolution. No other adverse events of postoperative wound complications, readmissions, medication reactions, thrombosis, or persistent pain were documented. CONCLUSION In forefoot surgery, the opioid-free pain management protocol was statistically noninferior to the opioid-containing protocol in reducing postoperative pain. LEVEL OF EVIDENCE Level II, prospective cohort study.
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Affiliation(s)
| | - Susan M Odum
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Nady Hamid
- OrthoCarolina Foot and Ankle Institute, Charlotte, NC, USA.,Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Todd A Irwin
- OrthoCarolina Foot and Ankle Institute, Charlotte, NC, USA.,Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
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Korwin-Kochanowska K, Potié A, El-Boghdadly K, Rawal N, Joshi G, Albrecht E. PROSPECT guideline for hallux valgus repair surgery: a systematic review and procedure-specific postoperative pain management recommendations. Reg Anesth Pain Med 2020; 45:702-708. [PMID: 32595141 PMCID: PMC7476301 DOI: 10.1136/rapm-2020-101479] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/18/2020] [Accepted: 05/24/2020] [Indexed: 11/17/2022]
Abstract
Hallux valgus repair is associated with moderate-to-severe postoperative pain. The aim of this systematic review was to assess the available literature and develop recommendations for optimal pain management after hallux valgus repair. A systematic review using PROcedure SPECific Postoperative Pain ManagemenT (PROSPECT) methodology was undertaken. Randomized controlled trials (RCTs) published in the English language from inception of database to December 2019 assessing postoperative pain using analgesic, anesthetic, and surgical interventions were identified from MEDLINE, EMBASE, and Cochrane Database, among others. Of the 836 RCTs identified, 55 RCTs and 1 systematic review met our inclusion criteria. Interventions that improved postoperative pain relief included paracetamol and non-steroidal anti-inflammatory drugs or cyclo-oxygenase-2 selective inhibitors, systemic steroids, ankle block, and local anesthetic wound infiltration. Insufficient evidence was found for the use of gabapentinoids or wound infiltration with extended release bupivacaine or dexamethasone. Conflicting evidence was found for percutaneous chevron osteotomy. No evidence was found for homeopathic preparation, continuous local anesthetic wound infusion, clonidine and fentanyl as sciatic perineural adjuncts, bioabsorbable magnesium screws, and plaster slippers. No studies of sciatic nerve block met the inclusion criteria for PROSPECT methodology due to a wider scope of included surgical procedures or the lack of a control (no block) group. The analgesic regimen for hallux valgus repair should include, in the absence of contraindication, paracetamol and a non-steroidal anti-inflammatory drug or cyclo-oxygenase-2 selective inhibitor administered preoperatively or intraoperatively and continued postoperatively, along with systemic steroids, and postoperative opioids for rescue analgesia.
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Affiliation(s)
- Katarzyna Korwin-Kochanowska
- Department of Cardiovascular Sciences and Department of Anesthesiology, University Hospitals of the KU Leuven, Leuven, Belgium
| | - Arnaud Potié
- Department of Anaesthesia, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Kariem El-Boghdadly
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, King's College London, London, United Kingdom
| | - Narinder Rawal
- Department of Anesthesiology and Intensive Care, University Hospital of Örebro, Örebro, Sweden
| | - Girish Joshi
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, United States
| | - Eric Albrecht
- Department of Anaesthesia, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
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D'Amato T, Martorelli F, Fenocchio G, Simili V, Kon E, Di Matteo B, Scardino M. Tapentadol vs oxycodone/naloxone in the management of pain after total hip arthroplasty in the fast track setting: an observational study. J Exp Orthop 2019; 6:36. [PMID: 31359202 PMCID: PMC6663946 DOI: 10.1186/s40634-019-0204-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 07/15/2019] [Indexed: 11/29/2022] Open
Abstract
Background 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. Methods 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. Results 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). Conclusion 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.
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Affiliation(s)
- Tiziana D'Amato
- Department of Anesthesia, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Federica Martorelli
- Department of Anesthesia, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giorgia Fenocchio
- Department of Anesthesia, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Vincenzo Simili
- Department of Anesthesia, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Elizaveta Kon
- Department of Biomedical Sciences, Humanitas University, Via Manzoni 113, 20089, Rozzano, Milan, Italy.,Humanitas Clinical and Research Center, Via Manzoni 56, 20089, Rozzano, Milan, Italy.,First Moscow State Medical University - Sechenov University, Moscow, Russia
| | - Berardo Di Matteo
- Department of Biomedical Sciences, Humanitas University, Via Manzoni 113, 20089, Rozzano, Milan, Italy. .,Humanitas Clinical and Research Center, Via Manzoni 56, 20089, Rozzano, Milan, Italy. .,Center for functional and biologic reconstruction of the Knee Humanitas Clinical and Research Institute, Via Manzoni 113, 20089, Rozzano, Italy.
| | - Marco Scardino
- Department of Anesthesia, Humanitas Research Hospital, Rozzano, Milan, Italy
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Ffrench-O'Carroll R, Steinhaeuser H, Duff S, Close J, McNamara J, Ahmed N, Murray M, Rice T, Immanni S. A randomized controlled trial comparing tapentadol with oxycodone in non-breastfeeding women post elective cesarean section. Curr Med Res Opin 2019; 35:975-981. [PMID: 30444145 DOI: 10.1080/03007995.2018.1550059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Tapentadol may allow greater pain relief with reduced "opioid load" compared to oxycodone. Its use has not been studied in the obstetric population. The objective of this study was to compare the efficacy and side effect profile of tapentadol with oxycodone in patients who received spinal anesthesia for elective cesarean section. The trial was registered with EU Clinical Trials Register with CT number 2016-001621-33. METHODS This was a multicenter, randomized controlled trial. Randomized patients (n = 68) received either 50 mg tapentadol or oxycodone 10 mg 12 hourly postoperatively. The primary endpoint was the sum of pain intensity difference over the first 48 hours of treatment (SPID48). Secondary outcomes included time to rescue medications, SPID36, total pain relief (TOTPAR) scores, patient satisfaction scores, sum of total pain relief and pain intensity difference (SPRID) scores, time to rescue medications and side effects experienced. An analysis of covariance model with baseline pain intensity score as a covariate was used for statistical analysis. RESULTS There was no significant difference in the primary endpoint of SPID48 with adjusted mean difference -11.45 (95% CI -35.35, 12.45) p = .34). Oxycodone showed significantly greater SPID36 scores compared to tapentadol with increased time to rescue medication. Side effects experienced were similar between groups. CONCLUSION Tapentadol did not provide superior pain control or improved tolerability compared to oxycodone post cesarean section. Results should be interpreted however with consideration of administration of intrathecal opioids to all patients in this study and debate over the optimal dose of tapentadol for acute pain.
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Affiliation(s)
| | | | - S Duff
- a University Hospital Waterford , Waterford , Ireland
| | - J Close
- a University Hospital Waterford , Waterford , Ireland
| | - J McNamara
- a University Hospital Waterford , Waterford , Ireland
| | - N Ahmed
- b St Luke's General Hospital , Kilkenny , Ireland
| | - M Murray
- a University Hospital Waterford , Waterford , Ireland
| | - T Rice
- c South Tipperary General Hospital , Clonmel , Ireland
| | - S Immanni
- a University Hospital Waterford , Waterford , Ireland
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Singla NK, Meske DS, Desjardins PJ. Exploring the Interplay between Rescue Drugs, Data Imputation, and Study Outcomes: Conceptual Review and Qualitative Analysis of an Acute Pain Data Set. Pain Ther 2017; 6:165-175. [PMID: 28676997 PMCID: PMC5693805 DOI: 10.1007/s40122-017-0074-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Indexed: 11/01/2022] Open
Abstract
In placebo-controlled acute surgical pain studies, provisions must be made for study subjects to receive adequate analgesic therapy. As such, most protocols allow study subjects to receive a pre-specified regimen of open-label analgesic drugs (rescue drugs) as needed. The selection of an appropriate rescue regimen is a critical experimental design choice. We hypothesized that a rescue regimen that is too liberal could lead to all study arms receiving similar levels of pain relief (thereby confounding experimental results), while a regimen that is too stringent could lead to a high subject dropout rate (giving rise to a preponderance of missing data). Despite the importance of rescue regimen as a study design feature, there exist no published review articles or meta-analysis focusing on the impact of rescue therapy on experimental outcomes. Therefore, when selecting a rescue regimen, researchers must rely on clinical factors (what analgesics do patients usually receive in similar surgical scenarios) and/or anecdotal evidence. In the following article, we attempt to bridge this gap by reviewing and discussing the experimental impacts of rescue therapy on a common acute surgical pain population: first metatarsal bunionectomy. The function of this analysis is to (1) create a framework for discussion and future exploration of rescue as a methodological study design feature, (2) discuss the interplay between data imputation techniques and rescue drugs, and (3) inform the readership regarding the impact of data imputation techniques on the validity of study conclusions. Our findings indicate that liberal rescue may degrade assay sensitivity, while stringent rescue may lead to unacceptably high dropout rates.
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Affiliation(s)
- Neil K Singla
- Lotus Clinical Research, Huntington Hospital, Department of Anesthesiology, Pasadena, CA, USA.
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Shah D, Shah S, Mahajan A, Shah N, Sanghvi D, Shah R. A comparative clinical evaluation of analgesic efficacy of Tapentadol and ketorolac in mandibular third molar surgery. Natl J Maxillofac Surg 2017; 8:12-18. [PMID: 28761271 PMCID: PMC5512403 DOI: 10.4103/njms.njms_4_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: The surgical removal of impacted mandibular third molars is one of the most commonly performed dentoalveolar procedures in oral and maxillofacial surgery and is associated with varying degrees of postoperative discomfort. Pain, trismus, and swelling are the most common postoperative complaints, and these influence a patient's quality of life in the days after surgery. Materials and Methods: A comparative study of the 32 patients, 16 were allocated to receive ketorolac and 16 patients were allocated to receive tapentadol. As the data for this study were collected at different time points, analysis for the longitudinal study was done. The main outcome variable, pain level was measured in five-ordered categories. As we had ordinal data in our study, we first checked for marginal homogeneity through Cochran–Mantel–Haenszel test. Results: In the present study, the results show that there is no statistically significant difference between the two treatment groups (P = 0.1184). According to results, there is no significant group by time interaction, which means both drugs have shown almost equal efficacy at different time points. Similarly, there is no difference in efficacy of the two drugs across gender level. Conclusion: The present findings showed that there is no statistically significant difference between the two treatment groups, although ketorolac is more effective for immediate pain reduction than tapentadol. However, the overall reduction of pain using both groups has no significant difference.
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Affiliation(s)
- Dixit Shah
- Department of Oral and Maxillofacial Surgery, K. M. Shah Dental College and Hospital, Vadodara, Gujarat, India
| | - Sanket Shah
- Department of Oral and Maxillofacial Surgery, K. M. Shah Dental College and Hospital, Vadodara, Gujarat, India
| | - Amit Mahajan
- Department of Oral and Maxillofacial Surgery, K. M. Shah Dental College and Hospital, Vadodara, Gujarat, India
| | - Navin Shah
- Department of Oral and Maxillofacial Surgery, K. M. Shah Dental College and Hospital, Vadodara, Gujarat, India
| | - Darshan Sanghvi
- Department of Oral and Maxillofacial Surgery, K. M. Shah Dental College and Hospital, Vadodara, Gujarat, India
| | - Rishabh Shah
- Department of Oral and Maxillofacial Surgery, K. M. Shah Dental College and Hospital, Vadodara, Gujarat, India
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Xiao JP, Li AL, Feng BM, Ye Y, Wang GJ. Efficacy and Safety of Tapentadol Immediate Release Assessment in Treatment of Moderate to Severe Pain: A Systematic Review and Meta-Analysis. Pain Med 2016; 18:14-24. [DOI: 10.1093/pm/pnw154] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Förster M, Helfert S, Dierschke R, Großkopf M, Hüllemann P, Keller T, Baron R, Binder A. Evaluation of the antihyperalgesic effect of tapentadol in two human evoked pain models – the TapCapMentho pilot trial. Expert Opin Pharmacother 2016; 17:1717-25. [DOI: 10.1080/14656566.2016.1201071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- M. Förster
- Division of Neurological Pain Research and Therapy, Department of Neurology, Christian-Albrechts-Universität Kiel, Kiel, Germany
| | - S. Helfert
- Division of Neurological Pain Research and Therapy, Department of Neurology, Christian-Albrechts-Universität Kiel, Kiel, Germany
| | - R. Dierschke
- Division of Neurological Pain Research and Therapy, Department of Neurology, Christian-Albrechts-Universität Kiel, Kiel, Germany
| | - M. Großkopf
- Division of Neurological Pain Research and Therapy, Department of Neurology, Christian-Albrechts-Universität Kiel, Kiel, Germany
| | - P. Hüllemann
- Division of Neurological Pain Research and Therapy, Department of Neurology, Christian-Albrechts-Universität Kiel, Kiel, Germany
| | | | - R. Baron
- Division of Neurological Pain Research and Therapy, Department of Neurology, Christian-Albrechts-Universität Kiel, Kiel, Germany
| | - A. Binder
- Division of Neurological Pain Research and Therapy, Department of Neurology, Christian-Albrechts-Universität Kiel, Kiel, Germany
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Chen YJ, Chiang CC, Huang PJ, Huang J, Karcher K, Li H. Tapentadol immediate-release for acute postbunionectomy pain: a phase 3, randomized, double-blind, placebo-controlled, parallel-group study in Taiwan. Curr Med Res Opin 2015; 31:2001-9. [PMID: 26293513 DOI: 10.1185/03007995.2015.1082992] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of tapentadol immediate-release (IR) for treating acute pain following orthopedic bunionectomy surgery in a Taiwanese population. METHODS This was a phase 3, randomized, double-blind, placebo-controlled, parallel-group bridging study in which Taiwanese patients (N = 60) with moderate-to-severe pain following bunionectomy were randomized (1:1:1) to receive tapentadol IR 50 or 75 mg or placebo orally every 4-6 hours over a 72 hour period. The primary endpoint was the sum of pain intensity difference over 48 hours (SPID48), analyzed using analysis of variance. RESULTS Out of 60 patients randomized (mainly women [96.7%]; median age 44 years), 41 (68.3%) completed the treatment. Mean SPID48 values were significantly higher for tapentadol IR (p ≤ 0.006: 50 mg, p ≤ 0.004: 75 mg) compared with placebo. Between-group differences in LS means of SPID48 (vs. placebo) were tapentadol IR 50 mg: 105.6 (95% CI: 32.0; 179.2); tapentadol IR 75 mg: 126.6 (95% CI: 49.5; 203.7). Secondary endpoints including SPID at 12, 24, and 72 hours, time to first use of rescue medication, cumulative distribution of responder rates, total pain relief and sum of total pain relief and sum of pain intensity difference at 12, 24, 48, and 72 hours, and patient global impression of change showed numerically better results supporting that tapentadol IR (50 and 75 mg) was more efficacious than placebo in relieving acute pain. The most frequent treatment emergent adverse events reported in ≥ 10% patients in either group were dizziness, nausea, and vomiting. A limitation of this study may possibly include more controlled patient monitoring through 4-6 hour dosing intervals, which reflects optimal conditions and thus may not approximate real-world clinical practice. However, all treatment groups would be equally affected by such bias of frequent monitoring, if any, since it was a randomized and double-blind study. CONCLUSIONS Tapentadol IR treatment significantly relieved acute postoperative pain and was well tolerated in a Taiwanese population. ClinicalTrials.gov identifier: NCT01813890.
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Affiliation(s)
- Yeung-Jen Chen
- a a Chang Gung University, Chang Gung Memorial Hospital , Linkou Branch , New Taipei , Taiwan
| | - Chao-Ching Chiang
- b b Department of Orthopaedics & Traumatology , Taipei Veterans General Hospital , Taipei , Taiwan
- c c Department of Surgery, School of Medicine , National Yang-Ming University , Taipei , Taiwan
| | - Peng-Ju Huang
- d d Department of Orthopaedic Surgery , Kaohsiung Medical University Hospital College of Medicine, Kaoshiung Medical University , Kaohsiung City , Taiwan
| | - Jason Huang
- e e Janssen Research & Development LLC , Taiwan
| | | | - Honglan Li
- f f Janssen Research & Development LLC , NJ , USA
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Knezevic NN, Tverdohleb T, Knezevic I, Candido KD. Unique pharmacology of tapentadol for treating acute and chronic pain. Expert Opin Drug Metab Toxicol 2015. [DOI: 10.1517/17425255.2015.1072169] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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