Controlled-release oxycodone for the management of pediatric postoperative pain

Czarnecki, Michelle L.; Jandrisevits, Matthew D.; Theiler, Sarah C.; Huth, Myra Martz; Weisman, Steven J.

doi:10.1016/j.jpainsymman.2003.08.007

Cited by 33 publications

(20 citation statements)

References 17 publications

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“…Oxycodone is increasingly used in children, with efficacy shown in multiple settings: oral use in the emergency department for children with orthopaedic injuries (Charney et al, 2008 Level II;Koller et al, 2007 Level II); use of an oral controlled-release (CR) preparation as a step-down following PCA in adolescents after spinal fusion (Czarnecki et al, 2004 Level IV); IV bolus dose administration for postoperative rescue analgesia (Kokki, Laisalmi et al, 2006 Level IV); and IV PCA (in adolescents and adults) Level II).…”

Section: Oxycodonementioning

confidence: 99%

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Cohen

Smit

Andrianopoulos³

et al. 2017

Medical Journal of Australia

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Objectives: This study aimed to assess analgesia provided by acupuncture, alone or in combination with pharmacotherapy, to patients presenting to emergency departments with acute low back pain, migraine or ankle sprain. Design: A pragmatic, multicentre, randomised, assessor‐blinded, equivalence and non‐inferiority trial of analgesia, comparing acupuncture alone, acupuncture plus pharmacotherapy, and pharmacotherapy alone for alleviating pain in the emergency department. Setting, participants: Patients presenting to emergency departments in one of four tertiary hospitals in Melbourne with acute low back pain, migraine, or ankle sprain, and with a pain score on a 10‐point verbal numerical rating scale (VNRS) of at least 4. Main outcome measures: The primary outcome measure was pain at one hour (T1). Clinically relevant pain relief was defined as achieving a VNRS score below 4, and statistically relevant pain relief as a reduction in VNRS score of greater than 2 units. Results: 1964 patients were assessed between January 2010 and December 2011; 528 patients with acute low back pain (270 patients), migraine (92) or ankle sprain (166) were randomised to acupuncture alone (177 patients), acupuncture plus pharmacotherapy (178) or pharmacotherapy alone (173). Equivalence and non‐inferiority of treatment groups was found overall and for the low back pain and ankle sprain groups in both intention‐to‐treat and per protocol (PP) analyses, except in the PP equivalence testing of the ankle sprain group. 15.6% of patients had clinically relevant pain relief and 36.9% had statistically relevant pain relief at T1; there were no between‐group differences. Conclusion: The effectiveness of acupuncture in providing acute analgesia for patients with back pain and ankle sprain was comparable with that of pharmacotherapy. Acupuncture is a safe and acceptable form of analgesia, but none of the examined therapies provided optimal acute analgesia. More effective options are needed. Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12609000989246.

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Section: Oxycodonementioning

confidence: 99%

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Cohen

Smit

Andrianopoulos³

et al. 2017

Medical Journal of Australia

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“…Oral oxycodone (1.24 mg·kg −1 ·day −1 ) has been used after pediatric spinal surgery. This is a low dose; the mean ratio of conversion from parenteral morphine equivalents to oxycodone was 1 : 1 (74), and we anticipate a higher dose requirement for opioid‐dependent children. The smallest oxycodone dose is 5 mg, making it very applicable to the pediatric population.…”

Section: Intraoperative Considerationsmentioning

confidence: 95%

Perioperative management of the child on long‐term opioids

Geary

Negus

Anderson

et al. 2011

Pediatric Anesthesia

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The strategies used to manage children exposed to long-term opioids are extrapolated from adult literature. Opioid consumption during the perioperative period is more than three times that observed in patients not taking chronic opioids. A sparing use of opioids in the perioperative period results in both poor pain management and withdrawal phenomena. The child's pre-existing opioid requirement should be maintained, and acute pain associated with operative procedures should be managed with additional analgesia. This usually comprises short-acting opioids, regional or local anesthesia, and adjuvant therapies. Long-acting opioids, transdermal opioid patches, and implantable pumps can be used to maintain the regular opioid requirement. Intravenous infusion, nurse controlled analgesia, patient-controlled analgesia, or oral formulations are invaluable for supplemental requirements postoperatively. Effective management requires more than simply increasing opioid dose during this time. Collaboration of the child, family, and all teams involved is necessary. While chronic pain or palliative care teams and other staff experienced with the care of children suffering chronic pain may have helpful input, many pediatric hospitals do not have chronic pain teams, and many patients receiving long-term opioids are not palliative. Acute pain services are appropriate to deal with those on long-term opioids in the perioperative setting and do so successfully in many centers. Staff caring for such children in the perioperative period should be aware of the challenges these children face and be educated before surgery about strategies for postoperative management and discharge planning.

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“…Several studies in patients after noncardiac surgery reported good pain control and high patient satisfaction with rapid conversion of iv opioid analgesics to oral immediaterelease or controlled-release oxycodone. [4][5][6] A review of the recent literature 7 suggests that immediate-release and controlled-release oxycodone have similar efficacy in the treatment of noncancer pain and similar side effects. Controlled-release oxycodone may offer the advantage of less frequent dosing, thereby decreasing nursing workload.…”

Section: Conclusion : L'oxycodone Peroral Est Efficace Pour Un Contrômentioning

confidence: 99%

Early oral analgesia after fast-track cardiac anesthesia

Kogan

Medalion

Raanani

et al. 2007

Can J Anesth/J Can Anesth

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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.

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Controlled-release oxycodone for the management of pediatric postoperative pain

Cited by 33 publications

References 17 publications

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Perioperative management of the child on long‐term opioids

Early oral analgesia after fast-track cardiac anesthesia

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