Journal of cancer & allied specialties · 2026
Role of Preoperative Tapentadol in Reduction of Peri-operative Analgesics Requirements After Breast Conservative Surgery in Cancer Patients: A Randomized Controlled Trial.
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Saleem Yusra, Ashfaq Allah Ditta, Mehdi Syed Raza, Aleem Asad
Аннотация
INTRODUCTION: Tapentadol, a centrally acting μ-opioid receptor agonist and noradrenaline reuptake inhibitor, has shown promise in providing potent analgesia with fewer opioid-related side effects. This study evaluated its role as a pre-emptive analgesic in cancer patients undergoing breast conservation surgery.
MATERIALS AND METHODS: A prospective, double-blinded, randomized controlled trial was conducted on 70 American Society of Anesthesiologists class II adult females, scheduled for conservative breast surgery, randomized into two groups after informed consent. Group A received 75 mg oral tapentadol, and Group B an oral placebo, one hour before induction. Intraoperatively, more than 20% increase in mean arterial pressure from baseline, and postoperatively, pain score (at 1, 2, 3, and 4 hours) greater than 3 was treated with intravenous morphine (up to 0.1 mg/kg). Data regarding total morphine used (dose and number of patients) intra-operatively and postoperatively, time to first rescue dose, and pain scores postoperatively, and side effects were documented.
RESULTS: Mean intraoperative morphine requirement was significantly lower in the tapentadol group (1.11 ± 1.53 mg) compared with the placebo group (3.36 ± 1.60 mg; p < 0.001). Only 13 (37.1%) patients in the tapentadol group required intraoperative morphine compared to 31 (88.6%) in the placebo group (p < 0.001). Postoperative pain scores were lower in the tapentadol group at 1 hour (1.89 ± 0.83 vs 2.46 ± 1.15, p = 0.020) and 3 hours (1.06 ± 0.24 vs 1.23 ± 0.43, p = 0.042). Rescue morphine use post op was lower in the tapentadol group [5 (14.3%) vs.10 (28.6%), p = 0.145] with a longer time to first rescue dose (58.0 ± 21.7 vs. 43.5 ± 27.3 minutes, p = 0.290).
CONCLUSION: Pre-emptive tapentadol administration significantly reduced perioperative morphine use and improved postoperative pain scores at certain time points. However, the increase in time to first rescue analgesia was not statistically significant.
MATERIALS AND METHODS: A prospective, double-blinded, randomized controlled trial was conducted on 70 American Society of Anesthesiologists class II adult females, scheduled for conservative breast surgery, randomized into two groups after informed consent. Group A received 75 mg oral tapentadol, and Group B an oral placebo, one hour before induction. Intraoperatively, more than 20% increase in mean arterial pressure from baseline, and postoperatively, pain score (at 1, 2, 3, and 4 hours) greater than 3 was treated with intravenous morphine (up to 0.1 mg/kg). Data regarding total morphine used (dose and number of patients) intra-operatively and postoperatively, time to first rescue dose, and pain scores postoperatively, and side effects were documented.
RESULTS: Mean intraoperative morphine requirement was significantly lower in the tapentadol group (1.11 ± 1.53 mg) compared with the placebo group (3.36 ± 1.60 mg; p < 0.001). Only 13 (37.1%) patients in the tapentadol group required intraoperative morphine compared to 31 (88.6%) in the placebo group (p < 0.001). Postoperative pain scores were lower in the tapentadol group at 1 hour (1.89 ± 0.83 vs 2.46 ± 1.15, p = 0.020) and 3 hours (1.06 ± 0.24 vs 1.23 ± 0.43, p = 0.042). Rescue morphine use post op was lower in the tapentadol group [5 (14.3%) vs.10 (28.6%), p = 0.145] with a longer time to first rescue dose (58.0 ± 21.7 vs. 43.5 ± 27.3 minutes, p = 0.290).
CONCLUSION: Pre-emptive tapentadol administration significantly reduced perioperative morphine use and improved postoperative pain scores at certain time points. However, the increase in time to first rescue analgesia was not statistically significant.