Tapentadol vs oxycodone/naloxone in the management of pain after total hip arthroplasty in the fast track setting: an observational study

Xie

Evidence-Based Complementary and Alternative Medicine

et al. 2021

Objective. To observe the effect of Shou Hui Tong Bian capsule (polygonum multiflorum and aloe-based herbal capsule for cathartic effect) in rapid rehabilitation of joint surgery. Methods. A total of 98 patients undergoing perioperative joint surgery in our hospital from July 2019 to March 2020 were included in the study. According to the situation of arthroscopy and joint replacement therapy, the patients were randomly divided into a control group and an observation group, with 49 cases in each group. The control group was treated with conventional therapy. On the basis of the control group, the patients in the observation group were orally administrated with Shou Hui Tong Bian capsule, 2 capsules/time, 3 times/day. Both groups received continuous treatment for 14 days. The clinical effects, awakening time, postoperative exhaust time, and the number of patients with different degrees of abdominal distension in the four groups before and after treatment were observed and compared. Results. After treatment, the total effective rate of arthroscopy in the control group was 66.7%, which was significantly lower than 83.3% in the observation group ( P < 0.05 ). The total effective rate of joint replacement in the control group was 64.0%, which was significantly lower than 84.0% in the observation group ( P < 0.05 ). After arthroscopic treatment and joint replacement treatment, the recovery time and postoperative exhaust time of borborygmus in the observation group were significantly lower than those in the control group (both P < 0.05 ). After the treatment, the number of patients with different degrees of abdominal distension in the arthroscopic and joint replacement treatment group and the control group was significantly improved ( P < 0.05 ), and the observation group was significantly better than the control group ( P < 0.05 ). Conclusion. The curative effect of Shou Hui Tong Bian capsule on patients undergoing arthroscopic joint surgery and joint replacement during perioperative period is obviously superior to that of conventional treatment. It can effectively improve the total effective rate, shorten the first exhaust time, and increase the number of patients without abdominal distension after treatment. It was safe and effective, and worthy of clinical promotion.

Section: Discussionmentioning

confidence: 99%

Effect of Observation of Shou Hui Tong Bian Capsule (Polygonum Multiflorum and Aloe-Based Herbal Capsule for Cathartic Effect) in Rapid Rehabilitation of Joint Surgery

Xie

Evidence-Based Complementary and Alternative Medicine

et al. 2021

Current Medical Research and Opinion

“…A recent study conducted in LBP patients suggests that the combination therapy (tapentadol PR + pregabalin) exerts its best clinical efficacy in subjects characterized by severe sleep disturbances and little anxiety [72]. Moreover, a study by D'Amato et al showed the efficacy of the combination of tapentadol and ketoprofen after hip arthroplasty [73]. The combination with other analgesics allows to reduce the dosage of tapentadol, although further dedicated studies on this treatment approach are required, since data obtained to date are not fully positive.…”

Section: Chronic Back Painmentioning

confidence: 99%

Modulation of sensitization processes in the management of pain and the importance of descending pathways: a role for tapentadol?

Caraci

Coluzzi

Marinangeli

et al. 2020

This paper presents and discusses recent evidence on the pathophysiological mechanisms of pain. The role of tapentadol-an analgesic molecule characterized by an innovative mechanism of action (i.e., µ-opioid receptor [MOR] agonism and inhibition of noradrenaline [NA] reuptake [NRI])-in the modulation of pain, and the most recent pharmacological evidence on this molecule (e.g., the µ-load concept) are also presented and commented upon. Methods Narrative review. Results Solid evidence has highlighted the importance of central sensitization in the transition from acute to chronic pain. In particular, the noradrenergic system holds a major role in limiting central sensitization and the progression to chronic pain. Therefore, pharmacological modulation of the noradrenergic system appears to be a well-grounded strategy for the control of chronic pain. Tapentadol is characterized by a to-date-unique mechanism of action, since it acts both as a MOR agonist and as an inhibitor of NA reuptake. The synergistic interaction of these two mechanisms allows a strong analgesic effect by acting on both ascending and descending pathways. Of note, the reduced µ-load of tapentadol has two important consequences: first, it limits the risk of opioidrelated adverse events, as well as the risk of dependence; second, the NA component becomes predominant at least in some types of pain with consequent specific clinical efficacy in the treatment of neuropathic and chronic pain. Conclusions According to these characteristics, tapentadol appears suitable in the treatment of chronic pain conditions characterized by both a nociceptive and a neuropathic component, such as osteoarthritis or back pain.

Arthroscopy: The Journal of Arthroscopic & Related Surgery

“…Although less intriguing, the same concept of combining more elements to improve the outcome is common to many fields of human activity, including medicine. Let's think of drugs combining diuretics and angiotensin-converting enzyme inhibitors to increase the antihypertensive effect, or pain killers associating paracetamol to opioids or opioids to their receptor antagonist 1 : nothing unusual for practitioners of several medical specialties. Even in the field of injectables for osteoarthritis, we may recall products combining hyaluronic acid (HA) and corticosteroids for intra-articular use 2 : the obvious rationale is to take advantage of the simultaneous administration of different molecules with complementary mechanisms of action.…”

Section: See Related Article On Page 903mentioning

confidence: 99%

Editorial Commentary: Platelet-Rich Martini or Vodka Hyaluronate? The Dilemma of Drink Selection for the Modern Orthopaedic Surgeon

Matteo

Kon

2021

Self Cite

The number of options for intra-articular treatment of osteoarthritis has been growing over the years, and currently a wide range of injectables is available, from "traditional" products such as corticosteroids and hyaluronic acid (HA) to biologic agents like platelet-rich plasma (PRP) and mesenchymal stem cells. Although the ultimate goal is to exert a modulation on the intra-articular environment, these substances act through different mechanisms of action. The combination of different products may have a rationale in taking advantage of complementary actions, but the "additive" effect and the safety should be demonstrated before any recommendation of use. Recently, the combination of HA and PRP has been tested in some clinical trials, with outcomes apparently superior to those of HA and PRP alone. This strategy may open a new scenario for the future, provided that we put scientific evidence before the pressure of the market, especially when dealing with cell-based approaches, which, although very attractive for patients, still need solid data to support their use as injectables.