Patient-Controlled Analgesia versus Oral Controlled-Release Oxycodone – Are They Interchangeable for Acute Postoperative Pain after Laparoscopic Colorectal Surgeries?

Abstract

Background: Standard therapy for postoperative pain after laparoscopic colorectal surgeries at the Tan Tock Seng Hospital consists of intravenous morphine via patient-controlled analgesia (PCA) for the first 24–48 h, followed by oral analgesics. We compared the efficacy and safety of oral controlled-release (CR) oxycodone hydrochloride (OxyContin® tablets) and PCA after laparoscopic colorectal surgeries. Methods: Between March and August 2006 (phase 1 study), 14 patients underwent laparoscopic colectomy, laparoscopic hemicolectomy or laparoscopic-assisted anterior resections. All patients were on oral CR oxycodone with oral immediate-release oxycodone on an as-needed basis for breakthrough pain. Pain intensity, analgesic use, length of hospital stay and side effects were evaluated. These were compared to data obtained from a second study of a similar design where 9 patients underwent similar operations from October 2006 to July 2007 (phase 2 study) and were on PCA morphine. Results: All patients in the CR oxycodone and PCA morphine groups needed the opioid medication for only 2 days. There was no difference in mean (range) postoperative pain intensity scores between patients on oxycodone and those on PCA morphine for the 1st postoperative day [2.07 (0–5) vs. 2.78 (2–4) on a Visual Analogue Scale (VAS) from 0 to 10; p = 0.10] and the 2nd postoperative day [1.14 (0–2) vs. 1.67 (0–3); p = 0.10]. Generalized estimating equations with linear link function confirmed that there was a significant relief of pain in patients after operation. On average, the VAS score of pain was 1.00 units lower on day 2 when compared with day 1 (p < 0.01). The mean (range) doses of oxycodone used on the 1st and 2nd postoperative day were 13.57 mg (10–30) and 15.36 mg (10–30), and the mean (range) doses of morphine used on the 1st and 2nd postoperative day were 14.9 mg (8–28) and 16.3 mg (4–31), respectively. Incidence of nausea and vomiting was 14.2 and 20% for the CR oxycodone and PCA groups, respectively. Conclusions: Oral CR oxycodone 20 mg per day is a cheaper, convenient and an efficacious alternative analgesic to PCA opioids after laparoscopic colorectal surgery.

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.…”

“…The authors suggested that sub-therapeutic plasma levels (mean Cmax 10.0 ng/ mL) of oxycodone found in the study participants could have contributed to the lack of analgesic efficacy. Ho (25) compared the efficacy and safety of CR oxycodone and intravenous PCA morphine following laparoscopic colorectal surgery. Patients in the oxycodone group received CR oxycodone 10 mg postoperatively upon return to the ward followed by 10 mg twice a day as needed.…”

Maximizing value in opioid utilization: Is oxycodone immediate release a good option for pain management?

“…[67] Oral oxycodone was also reported to be a safe, effective, and cost-effective alternative to patient-controlled analgesia (PCA) systems using opioids for control of postoperative pain. [68] Oxycodone is available in intravenous, subcutaneous, intramuscular, and oral formulations. Route of administration may be an important consideration in prescribing: intravenous drugs are more expensive and require hospitalization, while oral agents are generally more inexpensive and convenient.…”

Optimized Anesthesia and Analgesic Regimen for Robotic Colorectal Surgery

“…Opioids are required for optimal analgesia in most colorectal procedures, however oral administration has been shown to be sufficient in laparoscopic colorectal surgery [55]. Furthermore, oral opioid administration compared to patient-controlled analgesia is safe, cheaper, does not require patient-education, and does not reduce mobility of the patient.…”