Post‐operative opioid‐related adverse events with intravenous oxycodone compared to morphine: A randomized controlled trial

Abstract

Background The value of intravenous oxycodone compared to morphine remains controversial. The purpose of this trial was to compare opioid‐related adverse events (ORAES) of intravenous oxycodone and morphine after total hip arthroplasty. Methods Patients scheduled for total hip arthroplasty were enrolled in this study of post‐operative pain treatment with intravenous oxycodone or intravenous morphine (ratio 1:1). After surgery, patients received similar drug regimens for titration in the post‐operative care unit followed by intravenous patient‐controlled analgesia (PCA). The primary outcome was the number of patients with ≥1 ORAEs within the first 24 hours defined as either nausea, vomiting, respiratory depression, pruritus, urinary retention requiring evacuation, allergy, hallucinations. Secondary outcomes included pain scores and opioid consumption. Results The analysis included 238 patients with similar characteristics. There were 55 patients with at least one ORAEs in the oxycodone group vs 46 in the morphine group: 48% vs 40%, P = .19; relative risk = 1.22 (0.91:1.63). Intravenous oxycodone vs intravenous morphine requirements were respectively (median, IQR): 6 (0‐11) vs 8 (0‐12) mg (P = .06) for titration, 15 (8‐26) vs 8 (5‐16) mg (P = .001) for PCA, and 22 (12‐37) mg vs 19 (11‐28) mg for cumulated intravenous consumption (P = .048). During the first 24 hours, there was no difference in secondary outcomes (oxycodone vs morphine, respectively, in %): nausea (15 vs 13), vomiting (5 vs 5), urinary retention (20 vs 12) or pain scores. Conclusion This study demonstrates that IV oxycodone did not significantly reduce ORAEs within the first 24 hours compared to similar ratio of IV morphine.

The optimal dose of oxycodone in PCIA after laparoscopic surgery for gastrointestinal cancer in elderly patients: A randomized controlled trial

“…Previous studies have shown that the adverse effects of oxycodone included nausea, vomiting, and dizziness (19)(20)(21). There was no significant difference in the incidence of postoperative nausea and vomiting among three groups in our study.…”

Effect of a Stepwise Opioid-sparing Analgesic Protocol on In-hospital Oxycodone Use and Discharge Prescription After Cesarean Delivery

“…There are some data which suggest that oxycodone is better than morphine after surgery but this is controversial and may be related to variable equipotency ratios in the different studies. In a recent randomized study; however, Cuvillon et al4 showed that oxycodone did not reduce the rate of opioid-related adverse events. In the present study, drugs administered and doses were collected and a reduced use of oxycodone was found but pain-related sores are not provided.…”

Analgesic efficacy of erector spinae plane blocks for lumbar spine surgery: a randomized double-blind controlled clinical trial

“…In the PACU, patients experiencing pain with an NRS >3 (NRS 0–10; from 0=no pain to 10=the worst pain imaginable) were given an intravenous titration of 3 mg of the drug under study (2 mg if body weight <60 kg) at 5 min intervals until an NRS ≤3 was obtained according to the protocol 20…”