Comparison of analgesic efficacy of oxycodone and fentanyl after total hip replacement surgery

Abstract

Background:Total hip replacement (THR) is often accompanied by severe postoperative pain. We aimed to study whether oxycodone can be an effective alternative for fentanyl in the management of early postoperative pain after total hip replacement.Methods:We conducted a randomized controlled trial on 46 patients scheduled to undergo THR. We followed a standard general anesthetic technique, with endotracheal intubation. Twenty minutes before the end of surgery, single bolus injection of fentanyl, 50 μg (fentanyl group [group F], n = 23) or oxycodone, 4 mg (oxycodone group [group O], n = 23) was administered intravenously. Numeric rating scale (NRS) was used to assess pain in the post-anesthesia care unit (PACU). All patients had intravenous patient-controlled analgesia (PCA) with 10 μg/kg of fentanyl for 48 hours. Intravenous boluses of 50 μg were administered for breakthrough pain. The cumulative opioid dose administered at 6, 12, 24, and 48 h after surgery were recorded. A P value of less than .05 was considered statistically significant.Results:The NRS of group O in the PACU was significantly lower (P <.05); fewer patients in group O required additional fentanyl boluses in the PACU (P <.05). The cumulative opioid requirement was significantly less in group O at 6, 12, 24, and 48 hours after surgery. (P <.05)Conclusions:A single bolus injection of oxycodone is more effective than that of fentanyl in the acute phase of postoperative pain after THR. It may be used as an alternative drug for fentanyl in pain control after orthopedic surgery.

<p>Comparison of Analgesic and Adverse Effects of Oxycodone- and Fentanyl-Based Patient-Controlled Analgesia in Patients Undergoing Robot-Assisted Laparoscopic Gastrectomy Using a 55:1 Potency Ratio of Oxycodone to Fentanyl: A Retrospective Study</p>

“…[15][16][17] Thus, a number of studies have been conducted with potency ratios of oxycodone to fentanyl of 75-100:1. 8,13,18,19 In these studies, during the postoperative period, oxycodone produced similar or better results in terms of analgesia than fentanyl while the incidences of adverse effects were higher. However, in terms of analgesic effects, opioids do not have a ceiling effect, and more effective analgesia can be achieved by higher doses.…”

“…Therefore, fentanyl has been more widely used for IV-PCA. 13 However, another hydrophilic opioid, oxycodone, has been introduced. This opioid showed lower sedation than morphine, and the incidence of other side effects were comparable with that of fentanyl.…”

Oxycodone versus other opioids analgesia after laparoscopic surgery: a meta-analysis

“…In these studies, the intensity of analgesic drugs has peaked at this time point. Fentanyl has a rapid onset of action (5-7 min), which is much faster than oxycodone (10-15min) [17]. Although morphine is considered to be a slower-acting drug, it was given to patients 10-15min before the end of surgery in Lens's study [13].…”

“…Vestibular sensitivity caused by opioids activating on the μ receptors in the vestibular epithelium may be involved in [17]. Nevertheless, the potential causes of the different incidence in dizziness till need to be further explored.…”

Oxycodone versus other opioids analgesia after laparoscopic surgery: a meta-analysis

“…In animal experiments and clinical observations have shown that oxycodone may occasionally be superior to, e.g., morphine and fentanyl in the treatment of visceral pain [2]. However, by utilizing a meta-analysis, one can detect treatment effects with greater power and estimate these effects with greater precision [11]. To allow an indirect comparison with existing evidence on the efficacy of oxycodone and other opioids options used in postoperative pain management after laparoscopic surgery a meta-analysis was performed.…”