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Abrishami R, Ranjbar MF, Modir A, Hejazi SK. Comparing the effects of pre-emptive oxycodone, diclofenac, and gabapentin on postoperative pain after tibia fracture surgery: A randomized clinical trail. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2024; 14:301-306. [PMID: 38988418 PMCID: PMC11232778 DOI: 10.4103/jwas.jwas_143_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 08/25/2023] [Indexed: 07/12/2024]
Abstract
Background Postoperative pain (POP) is one of the most common and most important types of pain. Objectives The aim of this study was to compare the effects of pre-emptive oxycodone, diclofenac, and gabapentin on postoperative pain (POP) among patients with tibia fracture surgery. Materials and Methods This double-blind three-group randomised controlled trial was conducted in 2023. Participants were 111 candidates for tibia fracture surgery under general anaesthesia. They were randomly allocated to oxycodone, gabapentin, and diclofenac groups through block randomisation. Baseline arterial oxygen saturation, heart rate, and blood pressure were documented before surgery and POP and sedation status were measured during postoperative recovery and 2, 4, 6, 12, and 24 h after surgery. Postoperative opioid analgesic use was also documented. The data were analysed using the SPSS software (v. 20.0) at a significance level of less than 0.05. Results Groups did not significantly differ from each other respecting participants' baseline age, gender, body mass index, arterial oxygen saturation, heart rate, blood pressure, and surgery duration (P > 0.05). Moreover, there were no significant differences among the groups respecting POP and sedation status at different measurement time points (P > 0.05), except for six hours after surgery at which the POP mean score in the gabapentin group was significantly less than the other two groups (P = 0.001). Among-group differences respecting postoperative use of opioid analgesics and medication side effects were also insignificant (P > 0.05). Conclusion Pre-emptive oxycodone, diclofenac, and gabapentin significantly reduce POP among patients with tibia fracture surgery, though gabapentin may produce more significant analgesic effects. All these three medications can be used for pre-emptive analgesia. Of course, the best pre-emptive analgesic agent is determined based on the opinion of the treating physician.
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Affiliation(s)
- Ramin Abrishami
- Research Center for Trauma in Police Operations, Directorate of Health, Rescue & Treatment, Police Headquarter, Tehran, Iran
| | - Mehri Farhang Ranjbar
- Research Center for Trauma in Police Operations, Directorate of Health, Rescue & Treatment, Police Headquarter, Tehran, Iran
| | - Amirreza Modir
- Student Research Committee, Arak University of Medical Sciences, Arak, Iran
| | - Seyyed Kamal Hejazi
- Research Center for Trauma in Police Operations, Directorate of Health, Rescue & Treatment, Police Headquarter, Tehran, Iran
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Kohaf N, Harby SA, Abd-Ellatief AF, Elsaid MA, Abdelmottaleb NA, Abd Elsalam TF. Comparison of Effectiveness and Safety of Oxycodone Hydrochloride and Fentanyl for Post-operative Pain Following Total Hip Arthroplasty: A Randomized Triple-Blind Trial. Anesth Pain Med 2024; 14:e142710. [PMID: 38725916 PMCID: PMC11078234 DOI: 10.5812/aapm-142710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/08/2024] [Accepted: 01/16/2024] [Indexed: 05/12/2024] Open
Abstract
Background Total hip replacement (THR) is frequently associated with intense post-surgical pain. Effective pain management is of crucial importance to improving patient's condition and increasing his/her satisfaction in the post-operative time. Objectives This study aimed to compare the analgesic effect and safety of oxycodone and fentanyl after THR. Methods Seventy-two cases scheduled for elective THR were included in this randomized, triple-blind trial. The patients were equally randomized into 2 groups: Fentanyl group (50 ug of fentanyl) and oxycodone group (oxycodone 4 mg). Drugs were received 20 min prior to the end of the operation. Results Post-operative visual analog scale (VAS) measurements at rest and movement at the post-anesthesia care unit (PACU) and in the ward, 2 h, 4 h, and 8 h post-operatively exhibited a significantly reduced value in the oxycodone group compared to the fentanyl group (P-value < 0.05). Time to first rescue for analgesia was delayed significantly in the oxycodone compared to the fentanyl group (P-value < 0.001). Fentanyl consumption (ug) in the 1st post-operative 12 h, 24 h, and 48 h decreased significantly in the oxycodone group compared to the fentanyl group (P-value < 0.001). Post-operative nausea, vomiting, headache, and pruritus were matched between the 2 groups (P > 0.05). Conclusions A bolus dose of 4 mg of oxycodone provided superior analgesic efficacy than 50 ug fentanyl as evidenced by significantly lower pain score, delayed onset to first request for analgesia, and the smaller amount of fentanyl consumption at 12, 24, and 48 h post-total hip arthroplasty compared to fentanyl. The incidence of adverse events was comparable between the 2 groups.
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Affiliation(s)
- Neveen Kohaf
- Lecturer of Clinical Pharmacy, Faculty of Pharmacy (Girls), Al-Azhar University, Cairo, Egypt
| | - Salama A Harby
- Lecturer of Anesthesiology, Intensive Care and Pain Management, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Ahmed F Abd-Ellatief
- Lecturer of Anesthesiology, Intensive Care and Pain Management, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Mohamed A Elsaid
- Lecturer of Anesthesiology, Intensive Care and Pain Management, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Neazy A Abdelmottaleb
- Assistant Professor of Anesthesiology, Intensive Care and Pain Management, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Tamer F Abd Elsalam
- Lecturer of Anesthesiology, Intensive Care and Pain Management, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt
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Lao WL, Song QL, Jiang ZM, Chen WD, Zheng XH, Chen ZH. The Effect of Oxycodone on Post-operative Pain and Inflammatory Cytokine Release in Elderly Patients Undergoing Laparoscopic Gastrectomy. Front Med (Lausanne) 2021; 8:700025. [PMID: 34540861 PMCID: PMC8440846 DOI: 10.3389/fmed.2021.700025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 07/30/2021] [Indexed: 12/23/2022] Open
Abstract
Background: To evaluate the effect of oxycodone on post-operative pain and inflammation in elderly patients undergoing laparoscopic gastrectomy. Methods: Sixty patients who were of both sexes, American Society of Anesthesiologists Physical Status (ASA-PS) Class I or II, over 65 years of age and undergoing an elective laparoscopic radical gastrectomy were randomly divided into two groups: an oxycodone group (Group O) including 20 males and 10 females and a sufentanil group (Group S) including 21 males and 9 females. The post-operative analgesia regimen was as follows: 40 mg of parecoxib sodium and 0.1 mg/kg of oxycodone was intravenously injected into Group O before the abdomen closure, while 40 mg of parecoxib sodium and 0.1 μg/kg of sufentanil was injected intravenously into Group S. Both groups were infiltrated with 20 ml of 1% ropivacaine at the end of the operation. The level of serum IL-6 and IL-10 were assayed immediately at the following timepoints: at the conclusion of surgery (T1), 1 h (T2), 6 h (T3), and 24 h (T4) after the completion of the surgery. The numerical rating scale (NRS), the Ramsay sedation score, analgesic-related adverse events, post-operative pulmonary inflammation events and the post-operative stay were recorded. Results: Compared with Group S, the serum IL-6 concentrations of Group O decreased at T3 and T4, while the serum IL-10 concentrations increased (P < 0.05). In Group O, the serum IL-6 concentrations at T3 and T4 were lower than those at T1 (P < 0.05). The incidence of post-operative nausea and vomiting (PONV) and pulmonary inflammation in Group O was lower than that in Group S (P < 0.05). At each time point, the NRS of visceral pain in Group O was lower than that in Group S. At 6 and 24 h after extubation, the NRS of incision pain in Group O was lower than that in Group S (P < 0.05). Conclusion: Oxycodone can regulate the level of inflammatory cytokines and reduce post-operative inflammatory response.
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Affiliation(s)
- Wei-Long Lao
- Shaoxing University School of Medicine, Shaoxing, China
| | - Qi-Liang Song
- Department of Anesthesia, Shaoxing People's Hospital, Shaoxing, China
| | - Zong-Ming Jiang
- Department of Anesthesia, Shaoxing People's Hospital, Shaoxing, China
| | - Wen-di Chen
- Department of Anesthesia, Shaoxing People's Hospital, Shaoxing, China
| | - Xian-He Zheng
- Department of Anesthesia, Shaoxing People's Hospital, Shaoxing, China
| | - Zhong-Hua Chen
- Shaoxing University School of Medicine, Shaoxing, China.,Department of Anesthesia, The First Affiliated Hospital of Shaoxing University, Shaoxing, China
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So KY, Jung KT, Jang BH, Kim SH. Effective dose of intravenous oxycodone depending on sex and age for attenuation of intubation-related hemodynamic responses. Turk J Med Sci 2021; 51:102-110. [PMID: 32777896 PMCID: PMC7991858 DOI: 10.3906/sag-2004-63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/06/2020] [Indexed: 11/15/2022] Open
Abstract
Background/aim Preoperative intravenous oxycodone may help to prevent or attenuate intubation-related hemodynamic responses (IRHRs), but its pharmacokinetics differs according to age and sex. Therefore, we investigated the 95% effective dose (ED95) of intravenous oxycodone for attenuating all IRHRs, depending on the age and sex of the study population. Materials and methods All patients were allocated to one of 6 groups: 1) 20–40 year old males, 2) 41–65yearold males, 3) 66–80 year old males, 4) 20–40 year old females, 5) 41–65yearold females, and 6) 66–80 year old females (groups YM, OM, EM, YF, OF, and EF, respectively). Using Dixon’s up-and-down method, the first patient in each group was slowly injected with intravenous oxycodone (0.1 mg kg-1) 20 min before intubation. The subsequent patient received the next oxycodone dose, which was decreased or increased by 0.01 mg kg-1, depending on the “success” or “failure” of attenuation of all IRHRs to within 20% of the baseline values at 1 min after intubation in the previous patient. After obtaining 8 crossover points, predictive ED95 was estimated with probit regression analysis. Results ED95 varied greatly according to age and sex. ED95was 0.133 mg kg-1, 0.181 mg kg-1, 0.332 mg kg-1, 0.183 mg kg-1, 0.108 mg kg-1, and 0.147 mg kg-1in groups YM, OM, EM, YF, OF, and EF, respectively. Conclusion ED95 is higher in males with increasing age but is ambiguous for females. ED95 is higher in males than in females over 40 years of age but is higher in females than in males under 41 years of age. However, after considering the age and sex of the study population, these results can be used as reference doses for further studies to verify the clinical effects of oxycodone for attenuating all IRHRs.
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Affiliation(s)
- Keum Young So
- Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Republic of Korea,Department of Anesthesiology and Pain Medicine, School of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Ki Tae Jung
- Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Republic of Korea,Department of Anesthesiology and Pain Medicine, School of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Bo Hyun Jang
- Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Republic of Korea,Department of Medicine, Graduate School of Chosun University, Gwangju, Republic of Korea
| | - Sang Hun Kim
- Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Republic of Korea,Department of Anesthesiology and Pain Medicine, School of Medicine, Chosun University, Gwangju, Republic of Korea
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Zhang J, Tu Q, Gan J, Miao S, Zhou Y, Li Q, Zheng C. Preemptive Anti-Stress Response Effects of Oxycodone Versus Sufentanil for Patients Undergoing Cardiac Valve Replacement-A Randomized Controlled Trial. Clin Pharmacol Drug Dev 2019; 9:321-329. [PMID: 31820593 DOI: 10.1002/cpdd.764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 11/19/2019] [Indexed: 12/23/2022]
Abstract
Patients undergoing cardiac valve replacement may experience cardiovascular adverse events during the preoperative period before anesthesia. The study was to compare the preemptive anti-stress response effects of oxycodone versus sufentanil for patients undergoing cardiac valve replacement. Ninety-four patients were enrolled and assigned to group Oxy, group Suf and group NS. Patients in group Oxy were administrated with oxycodone 0.1 mg/kg, group Suf received sufentanil 0.1 μg/kg and group NS were given equivalent volume of normal saline. The primary outcomes included serum levels of cortisol, norepinephrine, and adrenaline. The secondary outcomes involved bispectral index value and the observer's assessment of awareness/sedation grade, levels of mean arterial pressure, heart rate, and the adverse reactions. Compared to group NS, the serum levels of cortisol at T1 to T5 (P < .05), and levels of norepinephrine and adrenaline at T3 to T5 (P < .05) in group Oxy and Suf were lower. The bispectral index value and observer's assessment of awareness/sedation grade T1 to T2 (P < .05) in group Suf were lower than those in group Oxy and NS. Compared with group NS, the levels of mean arterial pressure and heart rate in group Oxy and Suf at T3 to T5 (P < .05) were lower. The incidence of coughing was significantly higher in group Suf (23.3%), but not in group NS (6.7%), than that in group Oxy (3.3%). The preemptive analgesia of oxycodone may be used to inhibit the stress response, without leading to excessive sedation and respiratory depression, which may also help to stabilize hemodynamics during preoperative period.
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Affiliation(s)
- Jian Zhang
- Department of Anesthesiology, Sichuan Provincial Hospital for Women and Children/Affiliated Women and Children's Hospital of Chengdu Medical College, Chengdu, China
| | - Qing Tu
- Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianhui Gan
- Department of Anesthesiology, Tangshan People's Hospital, Tangshan, China
| | - Shuai Miao
- Department of Anesthesiology, Wuxi People's Hospital, Nanjing Medical University, Wuxi, China
| | - Ying Zhou
- Department of Anesthesiology, the Third People's Hospital of Chengdu, Southwest Jiao Tong University, Chengdu, China
| | - Qiang Li
- Department of Anesthesiology, the Third People's Hospital of Chengdu, Southwest Jiao Tong University, Chengdu, China
| | - Chuandong Zheng
- Department of Anesthesiology, the Third People's Hospital of Chengdu, Southwest Jiao Tong University, Chengdu, China
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An Y, Zhao L, Wang T, Huang J, Xiao W, Wang P, Li L, Li Z, Chen X. Preemptive oxycodone is superior to equal dose of sufentanil to reduce visceral pain and inflammatory markers after surgery: a randomized controlled trail. BMC Anesthesiol 2019; 19:96. [PMID: 31185942 PMCID: PMC6560747 DOI: 10.1186/s12871-019-0775-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/31/2019] [Indexed: 01/27/2023] Open
Abstract
Background Postoperative visceral pain is common after surgery and previous studies have demonstrated that oxycodone is an effective treatment. In this study, we compared the effects of preemptive oxycodone to equal dose of sufentanil on postoperative pain and serum level of inflammatory factors (TNF-α, IL-6, IL-10) after laparoscopic cholecystectomy. Methods Forty patients undergoing laparoscopic cholecystectomy were randomized into preemptive oxycodone group or preemptive sufentanil group. Patients were given either oxycodone 0.1 mg/kg (oxycodone group, n = 20) or sufentanil 0.1 μg/kg (sufentanil group, n = 20) for preemptive analgesia. We evaluated pain/sedation scores at 0 h, 0.5 h, 2 h, 4 h, 6 h, 8 h and 24 h after surgery and measured serum concentrations of TNF-α, IL-6 and IL-10 before surgery and at 0 h, 6 h and 24 h after surgery. Results Twenty patients were recruited in each group. Numerical rating scale (NRS) of visceral pain in the oxycodone group at 2 h when resting (0.5(0,2.75) vs 3(2,4), P = 0.008) and moving (0.5(0,3) vs 3(2.25,4), P = 0.015) and 4 h when moving (2(0,3) vs 3(0,4.75), P = 0.043) after surgery were significantly lower than the sufentanil group. Serum concentrations of TNF-α at 6 h (38.68 ± 10.49 vs 73.02 ± 16.27, P<0.001) and 24 h (43.12 ± 8.40 vs 74.00 ± 21.30, P<0.001) in the oxycodone group were lower than the sufentanil group. Conclusions Preemptive oxycodone 0.1 mg/kg administration could effectively suppress visceral pain at 2 h and 4 h after surgery and had lower inflammatory marker, serum TNF-α, level when compared to equal dose of sufentanil. Trial registration Clinical trials registration number: ChiCTR-IOR-17013738http://www.chictr.org.cn/showproj.aspx?proj=17346. Date of registration: 6th December 2017.
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Affiliation(s)
- Yi An
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China.,National Clinical Research Center for Geriatric Disorders, Beijing, China
| | - Lei Zhao
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China. .,National Clinical Research Center for Geriatric Disorders, Beijing, China.
| | - Tianlong Wang
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China.,National Clinical Research Center for Geriatric Disorders, Beijing, China
| | - Jiapeng Huang
- Department of Anesthesiology, Jewish Hospital and Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, KY, USA
| | - Wei Xiao
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China.,National Clinical Research Center for Geriatric Disorders, Beijing, China
| | - Ping Wang
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China.,National Clinical Research Center for Geriatric Disorders, Beijing, China
| | - Lixia Li
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China.,National Clinical Research Center for Geriatric Disorders, Beijing, China
| | - Zhongjia Li
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China.,National Clinical Research Center for Geriatric Disorders, Beijing, China
| | - Xiaoxu Chen
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, China.,National Clinical Research Center for Geriatric Disorders, Beijing, China
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Wang J, Wang N, Zhou H, Wang Y. Effect of preoperative hydromorphone in patients undergoing laparoscopic radical gastrectomy. A double-blind, randomized and controlled trial. Saudi Med J 2019; 39:1023-1027. [PMID: 30284586 PMCID: PMC6201035 DOI: 10.15537/smj.2018.10.22852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: To determine the efficacy of preemptive hydromorphone for laparoscopic radical gastrectomy. Methods: The present prospective and double-blinded study was performed in the The First Hospital, Jilin University, Changchun, China, between July 2017 and April 2018. Fifty patients scheduled for laparoscopic radical, gastrectomy were equally randomized into 2 groups, which were administrated different drugs 10 minutes before surgery. Group P (the preemptive hydromorphone group) was administrated 2 mg hydromorphone (2 mL), and Group C (the control group) was administrated 2 mL normal saline intravenously. A standardized general anesthesia were conducted. Blood pressure and heart rate, postoperative morphine consumption, pain intensity, sedation status, and side effects were recorded. Results: Group C had larger intraoperative hemodynamic changes, higher postoperative visual analogue scale score, more morphine consumption and lower overall satisfaction degree than Group P. No difference was found between the 2 groups in sedation status and adverse effects. Conclusion: Preoperative 2 mg hydromorphone could reduce intraoperative changes of blood pressure and heart rate, postoperative pain intensity, and morphine consumption without an increase of adverse effects.
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Affiliation(s)
- Jinguo Wang
- Department of Urology, The First Hospital of Jilin University, Changchun, China. E-mail.
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