Intranasal Tapentadol Vs Intravenous Paracetamol for Postoperative Analgesia in Lower Limb Orthopaedic Surgeries Under Spinal Anaesthesia

Objective: We aimed to compare the analgesic effectiveness of intranasal tapentadol nasal spray 44.5 mg and intravenous (IV) paracetamol 1gm during postoperative period in patients undergoing lower limb orthopaedic surgeries under spinal anaesthesia. Methods: This prospective, randomized single blind clinical trial was carried out in a tertiary care teaching hospital. Patients aged between 18-60 years, of physical status ASA grade 1–3 were included in the study. Post-operative pain scores were measured using the visual analogue scale (VAS) in centimetre (cm) every 12 hours in 37 patients per group. The patients were administered either intranasal tapentadol or IV paracetamol every 6 hours for 72 hours, beginning 3 hours after surgery. Results: There was a significant group by intervention effect favouring intranasal tapentadol suggesting greater reduction in VAS pain scores after the intervention at 72 hours (estimate: −1.58 cm; standard error (SE):0.2; P <0.001). Group by time effect for all the measured time frames, except for 36 hours, favoured intranasal tapentadol with estimate values for greater reduction in VAS pain scores ranging from −0.8 cm to −1.6 cm. Discussion: The present study suggests that intranasal tapentadol results in greater reduction of post-operative pain compared to IV paracetamol in lower limb orthopaedic surgeries. The ease of administration of tapentadol may make it preferred option over IV paracetamol in such surgeries.