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

Abstract

Background: Opioids are the mainstay of pain management for acute postsurgical pain. Oral oxycodone is an opioid that can provide effective acute postoperative pain relief. Objectives: To evaluate the use of oral oxycodone for acute postoperative pain management. Study Design: This is a narrative review based on published articles searched in PubMed and Medline from 2003 to 2015 on oral oxycodone for acute postoperative pain management. Methods: Clinical trials related to the use of oral oxycodone for acute postoperative pain management were searched via PubMed and Medline from 2003 to 2015. The search terms used were “oral strong opioids,” “postsurgical,” “postoperative,” “post-surgical,” and “postoperative.” Treatment interventions were compared for analgesic efficacy, rescue medication use, side effects, recovery, length of hospital stay, and patient satisfaction. Results: There were 26 clinical trials included in the review. Oral oxycodone showed superior postoperative analgesic efficacy compared with placebo in patients undergoing laparoscopic cholecystectomy, abdominal or pelvic surgery, bunionectomy, breast surgery, and spine surgery. When compared with intravenous opioids, oral oxycodone provided better or comparable pain relief following knee arthroplasty, spine surgery, caesarean section, laparoscopic colorectal surgery, and cardiac surgery. One study of dental postsurgery pain reported inferior pain control with oral oxycodone versus rofecoxib. (withdrawn from the US market due to cardiac safety concerns). In many studies, the demand for rescue analgesia and total opioid consumption were reduced in the oxycodone treatment arm. Patients receiving oral oxycodone experienced fewer opioid-related side effects than those on other opioids, and had a similar occurrence of postoperative nausea and vomiting as patients on placebo. Furthermore, oral oxycodone did not prolong hospital stay and was associated with lower drug costs compared with epidural and intravenous analgesics. Oxycodone administered as part of a multimodal analgesic regimen produced superior pain relief with fewer side effects and a reduced hospital stay. Limitation: There is a limited number of randomized double blinded studies in individual surgical operations, thus making it more difficult to come up with definitive conclusions. Conclusion: Oral oxycodone appears to offer safe and effective postoperative analgesia, and is a well-accepted and reasonable alternative to standard intravenous opioid analgesics. Key words: Postoperative, pain, analgesia, oral oxycodone, opioid

Intravenous oxycodone compared to morphine for post-operative opioid-related adverse events in opioid naïve patients: a prospective randomized controlled trial

“…Doses of sufentanil and sevoflurane influence the level of PONV. In our study, both groups ultimately received equivalent doses and finally nausea or vomitng were similar between groups and with studies already published elsewhere [15,19,27,28].…”

“…In conclusion, for clinical purposes, oxycodone or morphine can be used as first-line i. Total dose of study drug (mg) 22 19 [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] 0.048…”

“…This rate appeared to be low but probably related to the systematic prevention of nausea used in this study (see method). With oxycodone, the incidence of PONV in the literature vary according to doserelated studies and route of administration (p.o., i.v., s.c…) [15][16][17][18][19]23]. In fact, no study appears to ultimately demonstrate superiority to oxycodone vs morphine.…”

“…However, since the 1990s, oxycodone has been proposed as an alternative to morphine, because by acting on the µ1-receptors and on the κ-2-opioid agonist, it leads to a better anti nociceptive effect for post-operative pain relief or cancer-related pain [8][9][10][11][12][13][14]. Oral studies have shown that oxycodone was associated with better pain control, less serious opioid-related adverse events (ORAEs) and a faster onset of action due to a better pharmacokinetic profile: higher oral bioavailability and lower plasma variability [15][16][17][18][19]. However, controversies have arisen as a result of recent clinical studies and meta-analysis that have shown that oxycodone does not reduce adverse events and pain relief, not to mention that appetite for oxycodone itself is decreasing, due to concerns about addiction and the bad reputation that this drug has acquired in opiate-related crises [11,13,14,[19][20][21][22][23].…”

Intravenous oxycodone compared to morphine for post-operative opioid-related adverse events in opioid naïve patients: a prospective randomized controlled trial

“…Several studies have shown that per os oxycodone was associated with better pain control, less serious opioid-related adverse events (ORAEs) and a faster onset of action due to a better pharmacokinetic profile: higher oral bioavailability and lower plasma variability [15][16][17][18][19]. However, controversies have arisen as a result of recent clinical studies and meta-analysis that have shown that per os oxycodone did not reduce adverse events and pain relief.…”