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MINERVA ANESTESIOLOGICA

A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care


Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2018 Jan 16

DOI: 10.23736/S0375-9393.18.12297-8

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Oral prolonged-release oxycodone/naloxone offers equivalent analgesia to intravenous morphine patient-controlled analgesia after total knee replacement. A randomized controlled trial

Alberto MANASSERO 1 , Andrea FANELLI 2, Susanna UGUES 1, Cristian BAILO 1, Stefano DALMASSO 3

1 Anesthesia and Intensive Care Unit, Department of Emergency and Critical Care, S. Croce e Carle Hospital, Cuneo, Italy; 2 Anesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, Policlinico S. Orsola-Malpighi, Bologna, Italy; 3 Department of Surgical Sciences, University of Turin, Turin, Italy


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BACKGROUND: The purpose of this study was to determine whether oral prolonged- release oxycodone-naloxone combination (OXN) could provide equivalent analgesia and a side-effect profile similar to intravenous morphine patient-controlled analgesia (IVPCA) for the control of pain in the immediate postoperative period after total knee replacement (TKR).
METHODS: All patients received a sciatic nerve block with 0.3% ropivacaine 15ml, femoral nerve block with 0.5% ropivacaine 20 ml, spinal anesthesia and postoperative continuous femoral nerve infusion (ropivacaine 0.2% 4ml/h). After surgery, patients were randomly allocated to receive either 10 +10 +5mg controlled release OXN oral administration 12 hourly or IVPCA with morphine (2mg bolus, no basal infusion). The primary outcome was the average rest and dynamic pain for the first 48 h postoperatively. Secondary outcomes were: post operative nausea vomiting (PONV) and the total morphine consumption.
RESULTS: OXN group experienced better pain control at rest during the first (0.89±1.54 vs. 1.27±1.82, P=0.0019) and second (1.03±1,69 vs. 1.65±2.05, P=0.0006) post-operative period. There was no statistically significant difference in pain score during movement between the two groups. The secondary outcome measures showed no significant differences in the total morphine consumption (12.04±1.1 vs. 11.46±3.7 mg, P=0.20) or PONV (0.6 ± 0.8 vs 0.8 ± 1.0, P=0.40).
CONCLUSIONS: This study show that in the immediate postoperative period after TKR, the patients receiving oral prolonged-release OXN experienced the same to better pain control than those receiving morphine IVPCA, with a similar degree of PONV.


KEY WORDS: Oxycodone naloxone combination - Patient-controlled analgesia - Knee replacement arthroplasty - Postoperative pain

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Publication History

Article first published online: January 16, 2018
Manuscript accepted: January 10, 2018
Manuscript revised: November 15, 2017
Manuscript received: July 13, 2017

Cite this article as

Manassero A, Fanelli A, Ugues S, Bailo C, Dalmasso S. Oral prolonged-release oxycodone/naloxone offers equivalent analgesia to intravenous morphine patient-controlled analgesia after total knee replacement. A randomized controlled trial. Minerva Anestesiol 2018 Jan 16. DOI: 10.23736/S0375-9393.18.12297-8

Corresponding author e-mail

manassero.al@ospedale.cuneo.it