Early oral analgesia after fast-track cardiac anesthesia

Abstract

Purpose: Oral analgesia after "fast-track" cardiac anesthesia has not been explored. The aim of this study was to compare two oral oxycodone analgesic regimens. Methods:One hundred-twenty patients scheduled for coronary artery bypass grafting were randomly assigned postoperatively to receive immediate-release oxycodone 5 mg and acetaminophen 325 mg (Percocet-5) (group I) per os four times daily, or controlled-release oxycodone 10 mg (OxyContin) (group II) per os every 12 hr and placebo twice daily. Acetaminophen 500 mg per os was used as first-line rescue medication, and immediate-release oxycodone (syrup form) 5 mg per os as second-line rescue medication. Pain intensity was assessed with a visual analogue scale on the first postoperative day, the morning after extubation, and thereafter four times daily for four days. Use of rescue medication and adverse events were recorded.Results: Baseline demographic and operation-related characteristics were similar in both groups. While pain control was good in both groups, the immediate-release group experienced less pain on all postoperative days (P = 0.003), required significantly less rescue medication, and had fewer adverse effects such as somnolence and nausea. Conclusion:Peroral oxycodone is effective for early pain control after fast-track cardiac anesthesia. Immediate-release oxycodone/acetaminophen appears to provide better analgesia and fewer side effects compared to controlled-release oxycodone.

Systematic Literature Review and Meta-Analysis of the Efficacy and Safety of Prescription Opioids, Including Abuse-Deterrent Formulations, in Non-Cancer Pain Management

“…http://onlinelibrary.wiley.com/doi/10.1111/pme.12233/suppinfo illustrates the study designs and patient characteristics of the component studies of this literature review. Of the 68 studies included in the literature review, the majority (k = 65) were clinical trials (i.e., randomized or open‐label) [12,15–73]. The remaining three studies were observational [74–76].…”

“…Forty‐four studies assessed the effects of LAOs (oxycodone [N = 13], fentanyl [N = 2], morphine [N = 19], tramadol [N = 8], methadone [N = 0], oxymorphone [N = 8]) [12,15–23,27,29,30,35,36,48–66,68–79], among which were six studies were with ADFs (morphine sulfate and naltrexone hydrochloride ER [N = 6]; oxycodone hydrochloride ER [N = 2]) [29,30,52,53,61,63,64,73]. Twenty‐two studies assessed the effects of SAOs (hydrocodone [N = 1], oxycodone [N = 13], tramadol [N = 7], codeine [N = 0]) [24–26,28,31–34,37–47,67,80,81], of which one study had an ADF as an active treatment (oxycodone hydrochloride controlled‐release [N = 1]) [28].…”

“…There were fewer men than women in most of the studies. All participants had non‐cancer‐related pain at enrollment with the most prevalent pain conditions being osteoarthritis (k = 15 studies) [16,17,19,22,23,29,30,35,49–51,53,55,66,73], low back pain (k = 15) [12,15,18,27,36,37,57–59,69,70,73,77–79], and postoperative pain (k = 14) [24–26,28,33,34,39–42,44,45,47,67].…”

Comparison of gabapentin and oxycodone-acetaminophen used for pre-emptive analgesia in patients undergoing double-port thoracoscopic pulmonary surgery: a randomized, double-blind, controlled trial.

“…In addition, the bioavailability of gabapentin decreases with increasing dose; therefore, we chose gabapentin(300mg) as the experimental dose. Kogan A1 et al [21] found that oxycodone-acetaminophen (5mg / 325mg) has better analgesic effect and less side effects than sustained-release oxycodone (10mg) in oral surgery EARS anesthesia.Davis KM et al [22] found that oral analgesia with oxycodone-acetaminophen may offer superior pain after cesarean delivery with fewer side-effects as compared with morphine patientcontrolled analgesia.A meta-analysis [23] showed that high doses of oxycodone-acetaminophen were associated with an increase in analgesic-related adverse events, but these adverse events were often described as mild or moderate and were not associated with withdrawal. Therefore, we chose oxycodone-acetaminophen(330 mg) containing oxycodone(5mg) and acetaminophen(325mg).…”

Umgang mit retardierten Opioiden in der perioperativen Schmerztherapie

“…Eine Vielzahl von Untersuchungen konnte in den letzten Jahren zeigen, dass die planmäßige und zeitlich begrenz te orale Gabe retardierter, starker Opi oide eine wirksame Therapiemöglich keit postoperativer Schmerzen darstellen kann [2,3,5,6,12]. Insbesondere der Ein satz von retardiertem Oxycodon (z.…”