A randomised trial of oral versus intravenous opioids for treatment of pain after cardiac surgery

Abstract

Background: Cardiac surgery and sternotomy are procedures accompanied by substantial postoperative pain which is challenging to treat. In general, intravenous (IV) opioids are used in the immediate postoperative phase, followed by oral opioids. Oral opioids are easier to use and generally less expensive. Our goal was thus to determine whether a new opioid preparation provides adequate analgesia after sternotomy. In particular, we tested the primary hypothesis that total opioid use (in morphine equivalents) is not greater with oral opioid compared with patient-controlled IV morphine. Our secondary hypothesis was that analgesic efficacy is similar with oral and IV opioids. Methods: A total of 51 patients having elective cardiac surgery were enrolled in this study. After rapid postoperative respiratory weaning, the patients were randomised into one of two groups receiving different types of analgesia: oral Targin (a combination of oxycodone-hydrochloride and the opioid antagonist naloxone hydrochloride-dihydrate) or patient-controlled IV morphine. Pain score (visual analogue scale), sedation (Ramsey score), respiratory rate and side effects were assessed at 3, 5, 7, 9 and 11 h after surgery, and every 6 h throughout the third postoperative evening. Results: The total opioid dose in morphine equivalent doses was significantly lower with oral opioid than with IV morphine (adjusted geometric means

Oral Oxycodone for Acute Postoperative Pain: A Review of Clinical Trials

“…Given that intrathecally administered morphine is more effective than intravenous morphine for postcaesarean pain relief (46), oral oxycodone appears to offer satisfactory analgesia in this pain setting. In postsurgical situations involving colorectal (25) and cardiac surgeries (20), the analgesic quality of oral oxycodone was comparable to intravenous morphine.…”

“…Following elective cardiac surgery, Ruetzler and colleagues (20) randomly assigned patients to receive either oral opioid (oxycodone/naloxone) or intravenous morphine PCA and compared the total opioid use and postoperative analgesic efficacy of the 2 groups (Table 9). After postoperative respiratory weaning, patients…”

Efectividad de la analgesia controlada por el paciente en el dolor agudo y crónico de los pacientes después de cirugía cardiaca: estudio prospectivo

“…En este estudio, además de la menor edad, la ansiedad y un perfil catastrofista, la presencia de dolor preoperatorio y de insomnio, se asoció también a una mayor intensidad del dolor. Se han descrito consumos medios de morfina intravenosa de 50 ± 15 mg en los tres primeros días del postoperatorio (18). Estos valores medios indican que los requerimientos de los pacientes pueden variar mucho.…”

“…Se han descrito otras opciones analgésicas efectivas desde un punto de vista multimodal (23,24), sin que haya suficiente evidencia para su recomendación generalizada. Se ha utilizado la analgesia epidural (25), la pregabalina (26), la oxicodona vía oral (27), la dexmedetomidina o la analgesia regional (bloqueo paravertebral (28), bloqueo intercostal o bloqueo paraesternal (29)).…”

Післяопераційний Біль У Дітей (Огляд Літератури)

“…Слід віддавати перевагу пероральному прийому ліків над парентеральним у хворих, які можуть харчуватися перорально. Післяопераційний біль може бути три-валим і потребувати постійного дозування протягом перших 24 годин [13].…”