Comparing the Efficacy and Safety of Two Analgesic Regimens After Cardiac Surgery: Slow Release and Breakthrough...

To compare the analgesic outcome of two oral opioid regimens after cardiac surgery.

A retrospective cohort study.

A single tertiary-care facility.

Opioid-naïve adult patients following cardiac surgery via a sternotomy.

Patients received 1 of 2 regimens after extubation, an oxycodone protocol or a tapentadol protocol. Each protocol contained at least 3 doses of a slow-release oral formulation with immediate-release doses of the same opioid for breakthrough analgesia. Both protocols included regular paracetamol. Other analgesia for refractory pain was as directed by the physician.

Daily worst pain score was documented at rest and on movement in patients prescribed the oxycodone protocol and those prescribed the tapentadol protocol for 7 days after extubation. There was no significant difference between the tapentadol and oxycodone groups in worst pain at rest (odds ratio [OR] 1.77; 95% confidence interval [CI], 0.56-5.65; p = 0.334) or worst pain on movement (OR, 3.23; 95% CI, 0.85-12.32; p = 0.086) over the first 7 days post extubation. Despite a rapid de-escalation of opioids, the documented worst pain at rest and on movement by day 7, decreased by 96% in the tapentadol group and by 94% in the oxycodone group.

This retrospective cohort study demonstrates that tapentadol compared to oxycodone is an effective alternative for managing pain after cardiac surgery performed via sternotomy.