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      Different Doses of Oxycodone for Endoscopic Injection Sclerotherapy of Esophageal Varices

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          Abstract

          Background

          The aim of the present study was to evaluate the effects of different doses of oxycodone during endoscopic injection sclerotherapy (EIS) for esophageal varices with painless sclerosing agents.

          Material/Methods

          A total of 119 patients were randomly divided into 3 groups: Group A, midazolam and 0.075 mg/kg oxycodone (n=40); Group B, midazolam and 0.1 mg/kg oxycodone (n=40); and Group C, midazolam and 0.125 mg/kg oxycodone (n=39). The main observation index was the incidence of body movement during the perioperative period. The secondary indices were additional propofol usage; postoperative analgesic usage; other adverse effects, such as hypoxia, myoclonus, and cough; and satisfaction scores for surgeons and patients.

          Results

          The incidence rates for body movement during the perioperative period in groups A, B, and C were 33%, 13%, and 0, respectively ( P<0.001). The satisfaction scores for surgeons and patients were highest in Group C (0.125 mg/kg oxycodone). The incidence rates for hypoxia before EIS were 15%, 8%, and 33% ( P=0.026) and during EIS were 23%, 3%, and 0% ( P<0.001), respectively. There were no significant between-group differences with respect to other adverse effects.

          Conclusions

          The ideal dose of oxycodone for perioperative analgesia during EIS for esophageal varices is 0.125 mg/kg.

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          Most cited references21

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          Updated Clinical Pharmacokinetics and Pharmacodynamics of Oxycodone.

          Mari Kinnunen, Panu Piirainen, Hannu Kokki … (2019)
          Global oxycodone consumption has increased sharply during the last two decades, and, in 2008, oxycodone consumption surpassed that of morphine. As oxycodone was synthesized in 1916 and taken to clinical use a year later, it has not undergone the same approval process required by today's standards. Most of the basic oxycodone pharmacokinetic (PK) data are from the 1990s and from academic research; however, a lot of additional data have been published over the last 10 years. In this review, we describe the latest oxycodone data on special populations, including neonates, children, pregnant and lactating women, and the elderly. A lot of important drug interaction data have been published that must also be taken into account when oxycodone is used concomitantly with cytochrome P450 (CYP) 3A inducers and inhibitors and/or CYP2D6 inhibitors. In addition, we gathered data on abuse-deterrent oxycodone formulations, and the PK of alternate administration routes, i.e. transmucosal and epidural, are also described.
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            Oxycodone-induced tolerance to respiratory depression: reversal by ethanol, pregabalin and protein kinase C inhibition

            Rob Hill, William Dewey, Eamonn Kelly … (2018)
            Background and Purpose Oxycodone, a prescription opioid, is a major drug of abuse, especially in the USA, and contributes significantly to opioid overdose deaths each year. Overdose deaths result primarily from respiratory depression. We have studied respiratory depression by oxycodone and have characterized how tolerance develops on prolonged exposure to the drug. We have investigated the role of PKC in maintaining tolerance and have examined whether ethanol or pregabalin reverses oxycodone‐induced tolerance. Experimental Approach Respiration was measured in male CD‐1 mice by whole‐body plethysmography. Mice were preinjected with oxycodone then implanted with mini‐pumps (s.c.) delivering 20, 45 or 120 mg·kg −1 ·day −1 oxycodone for 6 days and subsequently challenged with oxycodone (3 mg·kg −1 , i.p.) or morphine (10 mg·kg −1 , i.p.) to assess the level of tolerance. Key Results Oxycodone‐treated mice developed tolerance to oxycodone and cross tolerance to morphine‐induced respiratory depression. Tolerance was less with 20 mg·kg −1 ·day −1 than with 45 or 120 mg·kg −1 ·day −1 oxycodone treatment. At doses that do not depress respiration, ethanol (0.3 g·kg −1 ), pregabalin (20 mg·kg −1 ) and calphostin C (45 μg·kg −1 ) all reversed oxycodone‐induced tolerance resulting in significant respiratory depression. Reversal of tolerance was less in mice treated with oxycodone (120 mg·kg −1 ·day −1 ). In mice receiving ethanol and calphostin C or ethanol and pregabalin, there was no greater reversal of tolerance than seen with either drug alone. Conclusion and Implications These data suggest that oxycodone‐induced tolerance is mediated by PKC and that reversal of tolerance by ethanol or pregabalin may be a contributory factor in oxycodone overdose deaths.
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              Oxycodone versus sufentanil in adult patient-controlled intravenous analgesia after abdominal surgery

              Lichun Han, Yuqiang Su, Hongfei Xiong … (2018)
              Abstract Background: A randomized controlled trial was performed to compare analgesic effects and adverse effects of oxycodone and sufentanil in patient-controlled intravenous analgesia (PCIA) after abdominal surgery under general anesthesia. Methods: Adult patients undergoing elective abdominal surgery were randomly allocated into oxycodone and sufentanil groups according to the randomization sequence. Study personnel, health-care team members, and patients were masked to the group assignment throughout the study period. Oxycodone (0.1 mg/kg for endoscopy; 0.15 mg/kg for laparotomy) or sufentanil (0.1 μg/kg for endoscopy; 0.15 μg/kg for laparotomy) was administrated at the end of surgeries. Postoperative pain was controlled using PCIA. Bolus dose was 2 mg and 2 μg for oxycodone and sufentanil group, respectively. The lockout time was 5 minutes for all patients, and there was no background infusion for oxycodone group, whereas 0.02 μg/kg/h background infusion was administrated in sufentanil group. The primary outcomes were the total analgesic doses in PCIA, effective bolus times, the length of first bolus since patients returning to ward from postanesthesia care unit (PACU), rescue analgesic rate in PACU, numeric rating scales, functional activity scores, and patients’ satisfaction scores. Results: A total of 200 patients were screened, and 175 patients were enrolled. Patients were randomly assigned to oxycodone (n = 87) and sufentanil (n = 88) groups. Both oxycodone and sufentanil PCIA provided adequate postoperative pain relief. Patients in oxycodone group showed a shorter consciousness recovery time after surgery. The major adverse effect in patients from oxycodone group was nausea/vomiting, whereas multiple adverse complications including nausea/vomiting, pruritus, and respiratory depression were observed in patients from sufentanil group. Patients from oxycodone group showed significantly reduced analgesic drug consumption (calculated as equivalent dose of morphine), functional activity scores, and patient satisfaction scores. Discussion: Compared with sufentanil PCIA, oxycodone PCIA showed better analgesic effects, lower incidence of adverse complications, and less analgesic drug consumption during postoperative pain management.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Med Sci Monit
                Journal ID (iso-abbrev): Med Sci Monit
                Journal ID (publisher-id): Medical Science Monitor
                Title: Medical Science Monitor : International Medical Journal of Experimental and Clinical Research
                Publisher: International Scientific Literature, Inc.
                ISSN (Print): 1234-1010
                ISSN (Electronic): 1643-3750
                Publication date Collection: 2021
                Publication date (Electronic): 17 March 2021
                Publication date (Electronic preprint): 15 January 2021
                Volume: 27
                Pages: e929111-1-e929111-6
                Affiliations
                [1 ]Department of Anesthesiology, First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, P.R. China
                [2 ]Department of Joint Surgery, Jizhong Energy Xingtai Mig General Hospital, Xingtai, Hebei, P.R. China
                [3 ]Department of Zoology and Physiology, University of Wyoming, Laramie, WY, U.S.A.
                [4 ]Department of Anesthesiology, Beijing YouAn Hospital, Capital Medical University, Beijing, P.R. China
                Author notes
                Corresponding Author: HaiLi He, e-mail: shimane126@ 123456126.com
                [A]

                Study Design

                [B]

                Data Collection

                [C]

                Statistical Analysis

                [D]

                Data Interpretation

                [E]

                Manuscript Preparation

                [F]

                Literature Search

                [G]

                Funds Collection

                [*]

                Jie Yao and ChunXiao Song contributed equally to this work and should be considered co-first authors

                Article
                Publisher ID: 929111
                DOI: 10.12659/MSM.929111
                PMC ID: 7983318
                PubMed ID: 33727522
                SO-VID: e3612569-6259-489c-8812-cbd3eb521fef
                Copyright © © Med Sci Monit, 2021
                License:

                This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International ( CC BY-NC-ND 4.0)

                History
                Date received : 11 October 2020
                Date accepted : 06 January 2021
                Categories
                Subject: Clinical Research

                Keywords: endoscopy, digestive system,oxycodone,personal satisfaction
                Data availability:
                Keywords: endoscopy, digestive system, oxycodone, personal satisfaction

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