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      Effect of oxycodone patient-controlled intravenous analgesia after cesarean section: a randomized controlled study

      , ,

      Journal of Pain Research

      Dove Medical Press

      cesarean section, postoperative pain, oxycodone, sufentanil

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          Abstract

          Background

          Oxycodone is a semisynthetic μ-opioid receptor agonist with a potentially good analgesic efficacy in visceral pain. This study aims to compare the efficacy of oxycodone with sufentanil patient-controlled intravenous analgesia (PCIA).

          Methods

          One hundred and twenty primiparas undergoing elective cesarean section were randomized into four groups by different drugs of PCIA: group S (sufentanil 100 μg), group OS1 (sufentanil 70 μg, oxycodone 30 mg), group OS2 (sufentanil 50 μg, oxycodone 50 mg), and group O (oxycodone 100 mg). Ramosetron 0.3 mg was added to each group. In all groups, drugs were diluted to 100 mL and managed with a continuous infusion of 1 mL·h −1, a bolus dose of 2 mL, and a lockout interval of 15 min. The maximum dose of PCIA per hour was 10 mL. After surgery, pain scores, PCIA doses, and side effects were compared among groups.

          Results

          At all time points (6, 12, and 24 h after surgery), Numerical Rating Scale (NRS) of uterine cramping pain (NRS-U) scores in group O were lower than those in groups OS1 and S ( P<0.008) and NRS-U scores in groups OS2 and OS1 were lower than that in group S ( P<0.008). NRS of moving into the sitting position (NRS-S) scores in group O were lower than those in the other groups ( P<0.008). NRS-S scores in group OS2 were lower than those in groups OS1 and S ( P<0.008). At 12 and 24 h after surgery, NRS of incision pain at rest (NRS-R) scores in group O were lower than those in the other groups ( P<0.008). At all time points, NRS-R scores in group OS2 were lower than those in groups OS1 and S ( P<0.008). The number of PCIA boluses and amount of opioid consumption in group O were lower than those in groups OS1 and S at all time points ( P<0.008).

          Conclusion

          Oxycodone PCIA may be more effective than sufentanil PCIA for pain relief after cesarean section but the incidence of side effects needs further investigation.

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          Most cited references 24

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          Equianalgesic dose ratios for opioids. a critical review and proposals for long-term dosing.

          Clinicians involved in the opioid pharmacotherapy of cancer-related pain should be acquainted with a variety of opioids and be skilled in the selection of doses when the type of opioid or route of administration needs changing. The optimal dose should avoid under-dosing or overdosing, both associated with negative outcomes for the patient. Although equianalgesic dose tables are generally used to determine the new doses in these circumstances, the evidence to support the ratios indicated in these tables largely refers to the context of single dose administration. The applicability of these ratios to the setting of chronic opioid administration has been questioned. A systematic search of published literature from 1966 to September 1999 was conducted to critically appraise the emerging evidence on equianalgesic dose ratios derived from studies of chronic opioid administration. There were six major findings: 1) there exists a general paucity of data related to long-term dosing and studies are heterogeneous in nature; 2) the ratios exhibit extremely wide ranges; 3) methadone is more potent than previously appreciated; 4) the ratios related to methadone are highly correlated with the dose of the previous opioid; 5) the ratio may change according to the direction the opioid switch; and 6) discrepancies exist with respect to both oxycodone and fentanyl. Overall, these findings have important clinical implications for clinicians and warrant consideration in the potential revision of current tables. The complexity of the clinical context in which many switches occur must be recognized and also appreciated in the design of future studies.
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            Opioids and the gut: pharmacology and current clinical experience.

            This article reviews the pharmacology and physiology of opiate receptors and the current and potential uses of opioid agonists and antagonists in clinical gastroenterology. Mu-receptors are involved in motor and sensory functions, and their modulation is established for treatment of diarrhea. Mu-antagonists have potential to reverse endogenous (e.g., postoperative ileus) or iatrogenic dysmotility (e.g., opioid bowel dysfunction). Modulation of the function of kappa-receptors may be a novel approach to control visceral pain in functional gut disorders. Results of formal testing of novel opioid modulators are keenly awaited.
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              Post-cesarean delivery analgesia.

              Post-cesarean delivery pain relief is important. Good pain relief will improve mobility and can reduce the risk of thromboembolic disease, which is increased during pregnancy. Pain may also impair the mother's ability to optimally care for her infant in the immediate postpartum period and may adversely affect early interactions between mother and infant. Pain and anxiety may also reduce the ability of a mother to breast-feed effectively. It is necessary that pain relief be safe and effective, that it not interfere with the mother's ability to move around and care for her infant, and that it result in no adverse neonatal effects in breast-feeding women. The most commonly used modalities are systemic administration of opioids, either by intramuscular injection or i.v. by patient-controlled analgesia, and neuraxial injection of opioid as part of a regional anesthetic for cesarean delivery. These techniques have specific advantages and disadvantages which will be discussed in this review. In addition, there are new drug applications of potential benefit for the treatment of post-cesarean delivery pain.
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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                Journal of Pain Research
                Journal of Pain Research
                Dove Medical Press
                1178-7090
                2017
                10 November 2017
                : 10
                : 2649-2655
                Affiliations
                Department of Anesthesiology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
                Author notes
                Correspondence: Shen Sun, Department of Anesthesiology, Obstetrics and Gynecology Hospital of Fudan University, Number 128, Shenyang Road, Shanghai, 200090, China, Fax +86 21 6345 5090, Email sunshen1980@ 123456126.com
                [*]

                These authors contributed equally to this work

                Article
                jpr-10-2649
                10.2147/JPR.S142896
                5691949
                © 2017 Nie et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Categories
                Original Research

                Anesthesiology & Pain management

                sufentanil, oxycodone, postoperative pain, cesarean section

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