Tapentadol vs oxycodone/naloxone in the management of pain after total hip arthroplasty in the fast track setting: an observational study
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01.12.2019 |
D’Amato T.
Martorelli F.
Fenocchio G.
Simili V.
Kon E.
Di Matteo B.
Scardino M.
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Journal of Experimental Orthopaedics |
10.1186/s40634-019-0204-6 |
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© 2019, The Author(s). 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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Placebo analgesia
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01.01.2018 |
Tabeeva G.
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Nevrologiya, Neiropsikhiatriya, Psikhosomatika |
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© Ima-Press Publishing House. All rights reserved. Placebos are drugs, devices, or other treatments that are physically and pharmacologically inert. The placebo effects are therapeutic responses to the context of the treatment process. They are mediated by factors, such as training of a patient, his/her expectations associated with treatment, as well as social conditions, the features of cognitive functioning, etc. and can affect the clinical and physiological responses caused by the health status. The analgesic effects of placebo in different types of pain syndromes reach 25-80%. The formation of placebo analgesia involves the brain structures that belong to the pain matrix and are implicated in the basic processes of perception, in the mechanisms of pain modulation, and in a number of other cognitive and affective processes, as well as in the emotional reactions not caused by pain. A deeper understanding of the mechanisms of action of placebo analgesia can optimize the strategy of current pain therapy.
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