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Control of post-operative pain and rehabilitation compliance of patients undergoing knee replacement

Panella L*, Caserta AV, Ballarati R, Lopresti M & Parravicini L

Objective: A correct approach to the rehabilitation of a patient must include an appropriate pain treatment which considers the patient, their history and their needs; of the central analgesics, tapentadol possesses an exclusive MOR-NRI mechanism of action, with an improved efficacy and tolerability profile compared to traditional opioids. The aim of our work was to verify the extent to which pain conditions functional recovery in patients undergoing knee replacement and admitted for specialist rehabilitation after the orthopaedic surgery. Methods: The open study assessed the analgesia and tolerability of tapentadol PR (50 mg to 150 mg bid) compared to standard treatment (paracetamol 1000 mg bid), in patients in rehabilitation after knee replacement surgery with moderate to severe pain (baseline NRS ≥ 5) The observation lasted 3 weeks, during which there were 4 controls: baseline and after 7, 14 and 21 days. In addition to the dosage of the analgesics being assessed, the following parameters were considered: pain intensity (NRS 0-10), sleep quality (4-point scale), functional recovery (active/passive ROM), muscle tone, Barthel index, comorbidities (CIRS scale) and resilience. Any side effects were also recorded. Results: 144 patients (104 F/40 M, 44-84 years) were admitted: 91 received tapentadol PR and 53 paracetamol. At the baseline, the 2 groups were found to be homogeneous. During the study, more favourable progress was observed with tapentadol PR: in particular, pain, ROM and sleep quality showed statistically significant and faster improvement in the patients treated with tapentadol PR (P<0.01). At the end of the study, the pain intensity had fallen 4.3 points on the NRS scale (83%) with tapentadol PR, compared to 2.4 (48%) with paracetamol. Both drugs were well tolerated. Conclusion: So, for the patient in rehabilitation, tapentadol PR can represent a manageable analgesic that can control the pain, allowing the rehabilitation plan to be carried out.