A comparative study of oral tapentadol with thoracic epidural analgesia versus intravenous tramadol and paracetamol combination for postoperative analgesia in off pump CABG

Himanshu A. Shah, Jaishree S. B., Mrugank Bhavsar

Abstract


Background: Accurate management of post operative pain is quite impossible with single drug therapy approach. For this, our aim was to combine use of tapentadol tablet orally along with thoracic epidural in comparison with intravenous combined use of tramadol, paracetamol and diclofenac for postoperative analgesia in case CABG patients.

Methods: 60 patients of CABG (Coronary Artery Bypass Surgery) randomly and equally divided into two groups. Group TTE (Tab. Tapentadol -Thoracic Epidural, n=30) were given oral Tablet Tapentadol through NG (Nasogastric) tube at the time of shifting the patient from Operation Theatre to postoperative ward along with Tramadol through Thoracic epidural catheter. In Group TPD (Tramadol -Paracetamol -Diclofenac, n=30) were given Inj. Tramadol, Inj. Paracetamol IV at time of shifting of patient. If pain score is too high (>4) then additional analgesia were given with Diclofenac only if preoperative renal and hepatic profile were normal. Patients were monitored for duration of rescue analgesia, total no. of doses of analgesics in first 72 hours, total consumption of analgesics and response to physiotherapy.

Results: Duration of need of rescue analgesia was significantly longer in TTE group (p<0.05) while total no. of rescue doses were significantly more in group TPD (p<0.001). We also observed that patients of TTE group were recovered earlier, response to chest physiotherapy was significantly better and thus reduces their total length of ICU stay (p<0.05).

Conclusions: Our study concludes that Tapentadol with Thoracic epidural is very much effective as a multimodal analgesia approach in controlling acute postoperative pain after CABG. Tapentadol is quite a newer drug so its usefulness for other patients and different surgeries is still to be debated.


Keywords


CABG, Tapentadol, Thoracic epidural, Tramadol, Multimodal analgesia

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