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Chou R, Wagner J, Ahmed AY, et al. Treatments for Acute Pain: A Systematic Review [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2020 Dec. (Comparative Effectiveness Review, No. 240.)
Table 21Opioid agonist versus mixed agent for postoperative pain
Study, Year Quality | Interventions | Procedure; Followup Duration Sample Size | Pain Intensity Results | Other Results |
|---|---|---|---|---|
Daniels, 2009a145 Fair | A: Oxycodone 10 mg every 4 to 6 hours up to 72 hours B: Tapentadol 50 mg every 4 to 6 hours up to 72 hours C: Tapentadol 75 mg every 4 to 6 hours up to 72 hours | Bunionectomy; 48 and 72 hours n=755 | Sum of pain intensity differences (least squares mean [95% CI], sum of differences from 0.5 to 72 hours on a 0 to 10 scale): 119.9 (83.52 to 156.21) vs. 89.3 (52.93 to 125.70) vs. 120.0 (83.64 to 156.33); differences of A vs. B or C within noninferiority margin ≥30% improvement in pain intensity: 75.2% vs. 77.5% vs. 76.5% at 48 hours ≥50% improvement in pain intensity: 64.4% vs. 64.7% vs. 64.0% at 48 hours | Use of rescue medication: 3.2% vs. 6.2% vs. 1.4% |
Daniels, 2009b126 Fair | A: Oxycodone HCL 15 mg B: Tapentadol IR 50 mg; C: Tapentadol IR 75 mg D: Tapentadol IR 100 mg Day 1: 4 to 7 doses could be administered; Days 2 and 3: 4 to 6 doses could be administered | Bunionectomy; 12, 24, 48, and 72 hours n=482 | Sum of pain intensity differences (mean [SD] sum of differences through 72 hours on a 0 to 10 scale): 288 (170.67) vs. 207.9 (207.57) vs. 230.5 (189.36) vs. 271.1 (154.57) ≥30% improvement in pain intensity at 48 hours: 78.4% vs. 64.7% vs. 68.3% vs. 78.8% ≥50% improvement in pain intensity at 48 hours: 72.8% vs. 58.0% vs. 56.7% v. 70.3% | Rescue medication use: 9% vs. 19% vs. 14% vs. 10% Percent reporting “much improved” or “very much improved” overall status on 1 to 7 point VRS: 88% vs. 67% vs. 77% vs. 89% |
Ffrench-O’Carrol, 2019128 Fair | A. Oxycodone controlled release: 10 mg every 12 hours for 2 days B. Tapentadol controlled release: 50 mg every 12 hours for 2 days | Cesarean section; 36 hours and 2 days n=68 | Sum of pain intensity differences (mean [SD] sum of differences through 72 hours on a 0 to 10 scale × 24): 65.14 (70.23) vs. 74.54 (77.97), MD −11.45 (95% CI −35.35 to 12.45) | Satisfaction score (mean [SD] on 1 to 5 scale), at 2 days: 4.14 (0.84) vs. 4.34 (1.21); MD 0.032 (95% CI −0.47 to 0.53) |
Viscusi, 2019169 Fair | A: Morphine: 30 mg every 4 to 6 hours for 3 days B: Tapentadol: 75 mg every 4 to 6 hours for 3 days | Bunionectomy; 12 hours and 3 days n=189 | Sum of pain intensity differences (least squares mean [SD], sum of difference on 0 to 10 NRS from 0.5 hours): 8.1 (18.2) vs. 9.9 (18.5) at 12 hours, MD −1.80 (95% CI −7.07 to 3.47); 177.1 (279.7) vs. 108.2 (281.4) at 3 days, MD 68.90 (95% CI −11.63 to 149.43) | Use of rescue medication: 64.6% (62/96) vs. 49.5% (46/93); RR 1.31 (95% CI 1.01 to 1.68) Global impression much improved or very much improved: 88.2% (82/93) vs. 84.4% (81/96) |
Vorsanger, 2013170 Fair | A: Oxycodone 5 mg, then 5 to 10 mg every 4 to 6 hours up to 7 days B: Tapentadol 50 mg, then 50 to 100 mg every 4 to 6 hours for up to 7 days | Arthroscopic shoulder surgery; 3 and 7 days n=378 | Sum of pain intensity differences (mean [SD], sum of differences on 0 to 10 scale): 41.1 (10.32) vs. 32.1 (10.19) at 3 days, least squares MD 9.0 (95% CI −18.9 to 36.9) ; 121.3 (20.43) vs. 130.6 (20.20) at 7 days, least squares MD −9.3 (−64.7, 46.0) Pain intensity improved ≥30%: 34.4% (53/154) vs. 33.5% (53/158) at day 3, 42.2% (65/154) vs. 48.1% (76/158) at day 7 | Patient global impression much or very much improved: 69% (125/181) vs. 75% (144/192) |
Wirz, 2005171 Fair | A: Oxycodone 10 mg twice daily for 3 days B: Tramadol 100 mg twice daily for 3 days | Orthopedic surgery; 2 and 3 days n=57 | Pain intensity at rest (mean [SD NR], 0 to 100 VAS converted to 0 to 10 scale: 2.10 (1.64) vs. 1.71 (1.45) at day 2, p=0.32; 1.63 (1.54) vs. 1.06 (1.39) at day 3, p=0.16 | Rescue medication use: 30.8% (8/26) vs. 35.5% (11/31) |
- Table 21, Opioid agonist versus mixed agent for postoperative pain - Treatments ...Table 21, Opioid agonist versus mixed agent for postoperative pain - Treatments for Acute Pain: A Systematic Review
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