Respiratory safety of morphine, trimeperidine, and Tafalgin for postoperative analgesia: a retrospective secondary analysis of pharmacoepidemiological and clinical and economic data

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INTRODUCTION: Opioid-induced respiratory depression (OIRD) and related complications remain a key concern of postoperative analgesia, particularly in high perioperative-risk patients with obesity and type 2 diabetes mellitus (T2DM). OBJECTIVE: To compare the respiratory safety and clinico-economic outcomes of postoperative analgesia with morphine, trimeperidine, and Tafalgin in high-risk patients. MATERIALS AND METHODS: A retrospective secondary analysis of two datasets: a pharmacoepidemiological cohort of 6,000 patients (2,000 each in the Tafalgin, morphine, and trimeperidine groups) and a regional pharmacoeconomic cohort of 1,500 patients with T2DM and obesity (180, 675, and 645, respectively). Event rates were compared using Pearson's χ2 test, with Fisher's exact test for rare events, calculating relative risk (RR) and 95% CI; Tafalgin served as reference. RESULTS: Groups were comparable in baseline characteristics and surgical structure (all p > 0.05). The 6-month pneumonia rate was 1.15 % with Tafalgin vs 8.20 % with morphine (RR 7.13; 95% CI 4.63–10.98; p < 0.001) and 7.45 % with trimeperidine (RR 6.48; 95% CI 4.19–10.01; p < 0.001). In the regional cohort, complication rates were 5.56, 19.41, and 18.45 % (RR 3.49 and 3.32; p < 0.001). In class II–III obesity (BMI ≥ 35.0 kg/m2), Tafalgin's advantage increased with obesity severity: the number needed to treat (NNT) versus morphine fell from 4.2 to 3.1. Over a 12-month horizon, total direct costs per patient were lower with Tafalgin by 4,528–4,994 RUB, corresponding to a dominant strategy. CONCLUSIONS: Tafalgin use was associated with fewer respiratory complications and lower total direct costs than morphine and trimeperidine, with differences most pronounced in high-risk patients. Results should be interpreted in view of the retrospective and aggregated nature of the source data.