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

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

Design: A retrospective cohort study.

Setting: A single tertiary-care facility.

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

Interventions: 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.

Measurements and main results: 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.

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