Multicentre, prospective, double-blind, randomised controlled clinical trial comparing different non-opioid analgesic combinations with morphine for postoperative analgesia: the OCTOPUS study

Beloeil, Hélène; Albaladéjo, Pierre; Sion, Avshalom; Durand, Marjorie; Martinez, Valéria; Lasocki, Sigismond; Futier, Emmanuel; Verzili, D.; Minville, Vincent; Fessenmeyer, Christine; Belbachir, A.; Aubrun, Frédéric; Renault, Alain; Bellissant, Éric; Bedague, Damien; Blanié, Antonia; Casez, Myriam; Chanques, Gérald; Chaize, C.; Dessertaine, Géraldine; Ferré, Fabrice; Chevronnay, L. Gaide; Hébrard, Anne; Hespel, A.; Jaber, S; Jong, Adam de; Lahjaouzi, A.; Marino, M.; Moury, Pierre-Henri; Neau, A.C.; Protar, D.; Rhem, D.; Rineau, Emmanuel; Robin, Sylvaine; Rossignol, Elsa; Soucemarianadin, M.; Veaceslav, S.

doi:10.1016/j.bja.2018.10.058

Cited by 32 publications

(16 citation statements)

References 21 publications

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“…The sample‐size was calculated based on the ability to detect a significant difference in adverse events between the IV oxycodone and IV morphine groups with a 50% difference in occurrence of ORAEs (32% vs 16%) with 80% power, based on previous studies with morphine 1‐10 . The level of significance was set at two‐sided α = 0.05 to support the hypothesis that the ORAEs for the IV oxycodone group would be different from those of the IV morphine group.…”

Section: Methodsmentioning

confidence: 99%

“…A multimodal analgesic approach has recently been developed to enhance post‐operative rehabilitation and pain relief. This approach may lead to decreased consumption of opiods 1‐4 . Despite the increase in clinical research into non‐opioid analgesics, many patients still complain of severe post‐operative pain and require intravenous (IV) or oral opioids in the first few days post‐operatively 5‐7 .…”

Section: Introductionmentioning

confidence: 99%

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

Cuvillon

Alonso

L'Hermite

et al. 2020

Acta Anaesthesiol Scand

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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.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Cuvillon

Alonso

L'Hermite

et al. 2020

Acta Anaesthesiol Scand

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“…The misuse of prescribed opioids leading to the current opioid epidemic crisis has put greater emphasis on the development of non-opioid analgesic techniques to manage postoperative pain [1][2][3]. A large variety of regional anesthesia techniques have been commonly used to minimize postoperative pain [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

The effect of ultrasound-guided erector spinae plane block on postsurgical pain: a meta-analysis of randomized controlled trials

et al. 2020

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Background: The effect of erector spinae plane block has been evaluated by clinical trials leading to a diversity of results. The main objective of the current investigation is to compare the analgesic efficacy of erector spinae plane block to no block intervention in patients undergoing surgical procedures. Methods: We performed a quantitative systematic review of randomized controlled trials in PubMed, Embase, Cochrane Library, and Google Scholar electronic databases from their inception through July 2019. Included trials reported either on opioid consumption or pain scores as postoperative pain outcomes. Methodological quality of included studies was evaluated using Cochrane Collaboration's tool. Results: Thirteen randomized controlled trials evaluating 679 patients across different surgical procedures were included. The aggregated effect of erector spinae plane block on postoperative opioid consumption revealed a significant effect, weighted mean difference of − 8.84 (95% CI: − 12.54 to − 5.14), (P < 0.001) IV mg morphine equivalents. The effect of erector spinae plane block on post surgical pain at 6 h compared to control revealed a significant effect weighted mean difference of − 1.31 (95% CI: − 2.40 to − 0.23), P < 0.02. At 12 h, the weighted mean difference was of − 0.46 (95% CI: − 1.01 to 0.09), P = 0.10. No block related complications were reported. Conclusions: Our results provide moderate quality evidence that erector spinae plane block is an effective strategy to improve postsurgical analgesia.

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“…7 Opioids are continuously prescribed to patients with cancer, 8 patients with non-cancer-related chronic pain, 9 and patients with postoperative pain. 10 The continuous prescription of opioids leads to chronic opioid use. This may affect both innate and adaptive immunity, and may reduce the immune functioning, resulting in poorer health-related outcomes.…”

mentioning

confidence: 99%

Trends in chronic opioid use and association with five-year survival in South Korea: a population-based cohort study

Jeon

Choi

2019

British Journal of Anaesthesia

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Background: The Korean National Health Insurance Service (NHIS) was developed to provide population data for medical research. The aim of this study was to estimate trends in prescription opioid use in South Korea, and to determine the association between chronic opioid use and 5-yr mortality in cancer and non-cancer patients. Methods: A population-based cohort study was conducted amongst the South Korean adult population using data from the NHIS. Those prescribed a continuous supply of opioids for 90 days were defined as chronic opioid users. Multivariable Cox regression analysis was used to assess the association between chronic opioid use and 5-yr mortality. Results: The proportion of chronic weak opioid users increased from 1.03% in 2002 to 9.62% in 2015. The proportion of chronic strong opioid users increased from 0.04% in 2002 to 0.24% in 2015. In the 2010 cohort (n¼822 214), compared with non-users, chronic weak opioid users had a significantly lower 5-yr mortality (hazard ratio [HR]: 0.93; 95% confidence interval [CI]: 0.89e0.96; P<0.001), and chronic strong opioid users had a significantly higher 5-yr mortality (HR: 1.45; 95% CI: 1.28e1.63; P<0.001). Similar results were observed in non-cancer patients, but chronic weak opioid users were not significantly associated with 5-yr mortality in cancer patients (P¼0.063). Conclusions: In South Korea, chronic opioid use has increased since 2002. Chronic strong opioid use was associated with a higher 5-yr mortality, and chronic weak opioid use was associated with a slightly lower 5-yr mortality. However, the findings regarding chronic weak opioid users should be interpreted carefully because there might be residual confounders in this study. Further study is needed to confirm these retrospective findings.

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Multicentre, prospective, double-blind, randomised controlled clinical trial comparing different non-opioid analgesic combinations with morphine for postoperative analgesia: the OCTOPUS study

Cited by 32 publications

References 21 publications

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

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

The effect of ultrasound-guided erector spinae plane block on postsurgical pain: a meta-analysis of randomized controlled trials

Trends in chronic opioid use and association with five-year survival in South Korea: a population-based cohort study

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