Intravenous Oxycodone Versus Other Intravenous Strong Opioids for Acute Postoperative Pain Control: A Systematic Review of Randomized Controlled Trials

Abstract

Introduction Optimal pain management is crucial to the postoperative recovery process. We aimed to evaluate the efficacy and safety of intravenous oxycodone with intravenous fentanyl, morphine, sufentanil, pethidine, and hydromorphone for acute postoperative pain. Methods A systematic literature search of PubMed, Cochrane Library, and EMBASE databases was performed for randomized controlled trials published from 2008 through 2017 (inclusive) that evaluated the acute postoperative analgesic efficacy of intravenous oxycodone against fentanyl, morphine, sufentanil, pethidine, and hydromorphone in adult patients (age ≥ 18 years). Outcomes examined included analgesic consumption, pain intensity levels, side effects, and patient satisfaction. Results Eleven studies were included in the review; six compared oxycodone with fentanyl, two compared oxycodone with morphine, and three compared oxycodone with sufentanil. There were no eligible studies comparing oxycodone with pethidine or hydromorphone. Overall, analgesic consumption was lower with oxycodone than with fentanyl or sufentanil. Oxycodone exhibited better analgesic efficacy than fentanyl and sufentanil, and comparable analgesic efficacy to morphine. In terms of safety, there was a tendency towards more side effects with oxycodone than with fentanyl, but the incidence of side effects with oxycodone was comparable to morphine and sufentanil. Where patient satisfaction was evaluated, higher satisfaction levels were observed with oxycodone than with sufentanil and comparable satisfaction was noted when comparing oxycodone with fentanyl. Patient satisfaction was not evaluated in the studies comparing oxycodone with morphine. Conclusions Our findings suggest that intravenous oxycodone provides better analgesic efficacy than fentanyl and sufentanil, and comparable efficacy to morphine with less adverse events such as sedation. No studies comparing intravenous oxycodone with pethidine or hydromorphone were identified in this review. Better alignment of study methodologies for future research in this area is recommended to provide the best evidence base for a meta-analysis. Funding Mundipharma Singapore Holding Pte Ltd, Singapore. Electronic supplementary material The online version of this article (10.1007/s40122-019-0122-4) contains supplementary material, which is available to authorized users.

Pain Management During the COVID-19 Pandemic

“…Providing adequate analgesia should be achieved without significant adverse events, and opioids with minimal immunosuppressive characteristics may be reasonable options in such situations where opioid use is indicated. Buprenorphine is highly recommended [43], tramadol and oxycodone can be used as a second option [44], while morphine and fentanyl are not recommended due to side effects and addiction potential [43,45].…”

An evaluation of continuous subcutaneous infusions across seven NHS acute hospitals: is there potential for 48-hour infusions?

“… N.B Current evidence suggests that doses of parenteral morphine and parenteral oxycodone are equivalent ( i.e. 1:1) [ 26 ] …”

<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>

“…In addition, oxycodone has been reported to be associated with a higher incidence of other side effects than fentanyl, such as dizziness, headache, and sedation. 12,14,25 In particular, Park et al reported significantly higher rates of dizziness even at a potency ratio of 60:1. 8,12 However, according to the results of this study, oxycodone using a potency ratio of 55:1 would not increase the incidence of other side effects compared with fentanyl.…”