1. Introduction Postoperative pain following cardiothoracic surgery can delay rehabilitation, increase morbidity and mortality, and may lead to persistent pain in 40% of cases 1. Oxycodone (Oxy) remains the main oral analgesic prescribed in this patient group in our centre, but the side effect profile is a concern and includes constipation and nausea Tapentadol (Tp) is a centrally acting analgesic used in the treatment of moderate-severe pain with a favourable side gastrointestinal profile 2 that warrants consideration of it’s use in this patient group. Introduction Postoperative pain following cardiothoracic surgery can delay rehabilitation, increase morbidity and mortality, and may lead to persistent pain in 40% of cases 1. Oxycodone (Oxy) remains the main oral analgesic prescribed in this patient group in our centre, but the side effect profile is a concern and includes constipation and nausea Tapentadol (Tp) is a centrally acting analgesic used in the treatment of moderate-severe pain with a favourable side gastrointestinal profile 2 that warrants consideration of it’s use in this patient group. Methods A retrospective observational study identified individuals prescribed either product postoperatively using the controlled drug register. Inclusion creteria included all indvidulas who had non- emergency thoracic surgery in a 4 week period who were opioid naive pre-operatively and did not complain of any other chronic pain condiition. Medical records, drug charts, nursing records and early warning score charts were analysed to obtain information on patient demographics, surgery type, and analgesia, pain scores and side effects for 5 days following surgery. There was no pre-warning gievne to the nursing staff in relation to the study in order to capture present practise A standardised post-operative analgesic regimen was in place. Data analysis was performed using Microsoft Excel. Methods A retrospective observational study identified individuals prescribed either product postoperatively using the controlled drug register. Inclusion creteria included all indvidulas who had non- emergency thoracic surgery in a 4 week period who were opioid naive pre-operatively and did not complain of any other chronic pain condiition. Medical records, drug charts, nursing records and early warning score charts were analysed to obtain information on patient demographics, surgery type, and analgesia, pain scores and side effects for 5 days following surgery. There was no pre-warning gievne to the nursing staff in relation to the study in order to capture present practise A standardised post-operative analgesic regimen was in place. Data analysis was performed using Microsoft Excel. Objective To identify the consumption of Tp and Oxy following cardiothoracic surgery and assess the ideal starting dose for future stuies. Objective To identify the consumption of Tp and Oxy following cardiothoracic surgery and assess the ideal starting dose for future stuies. Results 18 individulas were prescribed either Oxy or Tp during the study period. One individual was excluded due to pre-treatment with pregabalin. Table 1 outline the demographic details of the 17 individuals (8 Tp; 9 Oxy) were included. No difference in the multimodal analgesia regimen, pain intensity, sedation or side effect profiles were noted pre or post-operatively. Figure 1 illustrates the mean 5 day consumption of Tp. This was 276.5mg + 104mg (equalling 55.2mg + 20.8mg oxycodone). Chi square analysis of the daily consumption of Tapentadol showed no difference in the 5-day pattern (X 2 (8) = 4.46, p= 0.3) Results 18 individulas were prescribed either Oxy or Tp during the study period. One individual was excluded due to pre-treatment with pregabalin. Table 1 outline the demographic details of the 17 individuals (8 Tp; 9 Oxy) were included. No difference in the multimodal analgesia regimen, pain intensity, sedation or side effect profiles were noted pre or post-operatively. Figure 1 illustrates the mean 5 day consumption of Tp. This was 276.5mg + 104mg (equalling 55.2mg + 20.8mg oxycodone). Chi square analysis of the daily consumption of Tapentadol showed no difference in the 5-day pattern (X 2 (8) = 4.46, p= 0.3) Tapentadol consumption in postoperative cardiothoracic surgery: an observational retrospective study to establish initial dose Dr. R. Fenton 1, Dr. D.Hegarty 2, M. O Leary 3 1 SpR in Anaesthesia, Cork Univeristy Hospital, 2 Consultant in Pain Management & Neuromodulation, 1 SpR in Anaesthesia, Cork Univeristy Hospital, 2 Consultant in Pain Management & Neuromodulation, Department of Pain Medicine, Cork University Hospital, 3 Clinical Pharmacist, Cork University Hospital. Irish Pain Society ASM 2015 Dept. Pain Management, Cork University Hospital, Ireland References 1.Mazzeffi M, Khelemsky Y: Poststernotomy pain: a clinical review.J Cardiothorac Vasc Anesth 2011, 25(6):1163-78 2.Afilalo M, Morlion B. Efficacy of tapentadol ER for managing moderate to severe chronic pain. Pain Physician 2013;16(1):27-40 References 1.Mazzeffi M, Khelemsky Y: Poststernotomy pain: a clinical review.J Cardiothorac Vasc Anesth 2011, 25(6):1163-78 2.Afilalo M, Morlion B. Efficacy of tapentadol ER for managing moderate to severe chronic pain. Pain Physician 2013;16(1):27-40 Discussion The development of Tapentadol (Palexia) as a novel centrally acting analgesicis the first pain reliever developed in over 25 years for the management of moderate-to-severe acute pain and severe chronic pain in adults. It is now recognised as a step III analgesic on the World Health Organisation (WHO) pain ladder.. We believe that Tapentadol offers several added advantages for managing pain in a patient population prone to an high incidence of persistent post operative pain (30-40%). These advantages include: a)Strong efficacy and favourable tolerability in the initial phase and in the long-term management b)Ease of conversion from classical opioids c)Low pharmacokinetic drug-drug interaction potential d)Low rate of abuse and diversion Our results suggests that the starting dose required in this cohort should be 150mg (SR) BD as it provides comparable analgesic cover to established treatments. Limitation of this study includes the retrospective study design, the small sample size and poor bedside recording of pain intensity and side effects. It does provide a value information for future projects Conclusion Tapendatol appers to offer a reasonable alternative with a better profile in this cohort. It provides a platform to design future studies As a result of our study an intensive edcuational programme has commence & an audit will follow Discussion The development of Tapentadol (Palexia) as a novel centrally acting analgesicis the first pain reliever developed in over 25 years for the management of moderate-to-severe acute pain and severe chronic pain in adults. It is now recognised as a step III analgesic on the World Health Organisation (WHO) pain ladder.. We believe that Tapentadol offers several added advantages for managing pain in a patient population prone to an high incidence of persistent post operative pain (30-40%). These advantages include: a)Strong efficacy and favourable tolerability in the initial phase and in the long-term management b)Ease of conversion from classical opioids c)Low pharmacokinetic drug-drug interaction potential d)Low rate of abuse and diversion Our results suggests that the starting dose required in this cohort should be 150mg (SR) BD as it provides comparable analgesic cover to established treatments. Limitation of this study includes the retrospective study design, the small sample size and poor bedside recording of pain intensity and side effects. It does provide a value information for future projects Conclusion Tapendatol appers to offer a reasonable alternative with a better profile in this cohort. It provides a platform to design future studies As a result of our study an intensive edcuational programme has commence & an audit will follow