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Abstract
Introduction
Optimal pain management is crucial to the postoperative recovery process. We aimed to evaluate the efficacy and safety of intravenous oxycodone with intravenous fentanyl, morphine, sufentanil, pethidine, and hydromorphone for acute postoperative pain.
Methods
A systematic literature search of PubMed, Cochrane Library, and EMBASE databases was performed for randomized controlled trials published from 2008 through 2017 (inclusive) that evaluated the acute postoperative analgesic efficacy of intravenous oxycodone against fentanyl, morphine, sufentanil, pethidine, and hydromorphone in adult patients (age ≥ 18 years). Outcomes examined included analgesic consumption, pain intensity levels, side effects, and patient satisfaction.
Results
Eleven studies were included in the review; six compared oxycodone with fentanyl, two compared oxycodone with morphine, and three compared oxycodone with sufentanil. There were no eligible studies comparing oxycodone with pethidine or hydromorphone. Overall, analgesic consumption was lower with oxycodone than with fentanyl or sufentanil. Oxycodone exhibited better analgesic efficacy than fentanyl and sufentanil, and comparable analgesic efficacy to morphine. In terms of safety, there was a tendency towards more side effects with oxycodone than with fentanyl, but the incidence of side effects with oxycodone was comparable to morphine and sufentanil. Where patient satisfaction was evaluated, higher satisfaction levels were observed with oxycodone than with sufentanil and comparable satisfaction was noted when comparing oxycodone with fentanyl. Patient satisfaction was not evaluated in the studies comparing oxycodone with morphine.
Conclusions
Our findings suggest that intravenous oxycodone provides better analgesic efficacy than fentanyl and sufentanil, and comparable efficacy to morphine with less adverse events such as sedation. No studies comparing intravenous oxycodone with pethidine or hydromorphone were identified in this review. Better alignment of study methodologies for future research in this area is recommended to provide the best evidence base for a meta-analysis.
Funding
Mundipharma Singapore Holding Pte Ltd, Singapore.
Details
; Belbachir, Anissa 2 ; El-Tallawy, Salah 3 ; Kok Yuen Ho 4 ; Nagtalon, Eric 5 ; Salti, Amar 6 ; Jeong-Hwa Seo 7 ; Aida Rosita Tantri 8 ; Wang, Hongwei 9 ; Wang, Tianlong 10 ; Kristal Cielo Buemio 11 ; Gutierrez, Consuelo 11 ; Hadjiat, Yacine 11 1 Pain Clinic, Christiaan Barnard Memorial Hospital, Cape Town, South Africa
2 Faculté de médecine, Université Paris-Descartes, Pôle d’anesthésie-réanimation, Hôpital Cochin, Paris, France
3 Department of Anesthesia and Pain Management, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
4 The Pain Clinic, Mount Alvernia Medical Centre, Singapore, Singapore
5 Department of Anesthesia, University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines
6 Anesthesiology Institute, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
7 Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
8 Department of Anesthesiology and Intensive Care, Universitas Indonesia, Dr. Ciptomangunkusumo National General Hospital, Jakarta, Indonesia
9 Department of Anesthesiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
10 Department of Anesthesiology, Xuanwu Hospital of Capital Medical University, Beijing, China
11 Mundipharma Singapore Holding Pte. Ltd., Singapore, Singapore