The role of perioperative tapentadol in inguinal hernia repair: Implications for acute analgesia and chronic postoperative pain – a narrative review

Chronic postoperative inguinal pain remains one of the most frequent complications after inguinal hernia repair. Tapentadol, with its dual mechanism of µ-opioid receptor agonism and noradrenaline reuptake inhibition, offers potential advantages in controlling both nociceptive and neuropathic components of pain. This narrative review summarizes experimental, preclinical, and clinical evidence on the use of tapentadol in perioperative analgesia, with focus on inguinal hernia surgery and prevention of chronic postoperative inguinal pain (CPIP). Relevant randomized trials, observational studies, and mechanistic data were evaluated. Available evidence suggests that tapentadol provides effective postoperative analgesia with a favorable gastrointestinal and central nervous system tolerability profile compared with traditional µ‑opioid agonists. Preemptive administration may reduce acute postoperative pain, opioid rescue requirements, and the risk of transition to chronic pain in high‑risk settings. Current evidence supports tapentadol as an effective component of perioperative analgesia in inguinal hernia surgery, particularly for reducing acute postoperative pain and opioid rescue requirements. However, its potential role in preventing chronic postoperative inguinal pain remains insufficiently established and should be considered hypothetical, pending confirmation from high-quality randomized controlled trials.