Reuben S S, Connelly N R, Maciolek H
Acute Pain Service, Baystate Medical Center and Tufts University School of Medicine, Springfield, Massachusetts 01199, USA.
Anesth Analg. 1999 Jun;88(6):1286-91. doi: 10.1097/00000539-199906000-00016.
Reconstruction of the anterior cruciate ligament (ACL) of the knee is associated with a considerable degree of postoperative pain. Although immediate-release oral opioids are usually effective in relieving moderate to severe pain, they must be given every 4-6 h. A controlled-release (CR) formulation of oxycodone maintains therapeutic opioid concentrations for a more prolonged period, thus providing sustained pain relief. We designed this study to determine whether CR oxycodone is more effective and clinically acceptable than immediate-release oxycodone for managing pain after ambulatory ACL repair surgery. All patients received a standard general anesthetic and postoperative analgesic regimen with one of three oxycodone dosing regimens: oxycodone 10 mg every 4 h as needed, oxycodone 10 mg every 4 h, and CR oxycodone 20 mg every 12 h. Rescue analgesic consisted of oxycodone 5 mg every 6 h as needed. At 24, 36, 48, 60, and 72 h, there was a difference in pain scores among the groups (P < 0.0001); there was less pain in the CR oxycodone group. At most times, the fixed-dose group had lower pain scores than the as-needed group. The sedation scores were significantly different at 12 h (P < 0.02) and at 24, 36, 48, 60, and 72 h (P < 0.0001); the patients were more alert in the CR oxycodone group. The 72-h consumption of oxycodone was less in the CR oxycodone group (P < 0.0001). The patients had less sleep disturbance (P < 0.0001), were more satisfied (P < 0.0001), and experienced less vomiting (P < 0.02) in the CR oxycodone group compared with the other two groups. In conclusion, using CR oxycodone in the immediate 72 h after ambulatory ACL surgery provides more effective analgesia with less sedation, sleep disturbance, and postoperative vomiting compared with oxycodone prescribed on either a fixed dose or as-needed schedule.
A controlled-release formulation of oxycodone in patients undergoing anterior cruciate ligament repair on an ambulatory basis provides significant analgesic benefit and a lowering of side effects compared with either fixed-dose or as-needed oxycodone regimens.
膝关节前交叉韧带（ACL）重建术后会伴有相当程度的疼痛。尽管即释型口服阿片类药物通常能有效缓解中度至重度疼痛，但必须每4 - 6小时给药一次。羟考酮控释（CR）制剂能在更长时间内维持治疗性阿片类药物浓度，从而提供持续的疼痛缓解。我们设计本研究以确定在门诊ACL修复手术后，CR羟考酮在控制疼痛方面是否比即释型羟考酮更有效且在临床上更可接受。所有患者均接受标准全身麻醉和术后镇痛方案，采用三种羟考酮给药方案之一：按需每4小时服用10毫克羟考酮、每4小时服用10毫克羟考酮以及每12小时服用20毫克CR羟考酮。解救镇痛药为按需每6小时服用5毫克羟考酮。在24、36、48、60和72小时时，各组间疼痛评分存在差异（P < 0.0001）；CR羟考酮组疼痛较轻。在大多数时间，固定剂量组的疼痛评分低于按需给药组。镇静评分在12小时时差异显著（P < 0.02），在24、36、48、60和72小时时差异也显著（P < 0.0001）；CR羟考酮组患者更清醒。CR羟考酮组72小时的羟考酮消耗量较少（P < 0.0001）。与其他两组相比，CR羟考酮组患者睡眠障碍较少（P < 0.0001）、满意度更高（P < 0.0001）且呕吐较少（P < 0.02）。总之，与按固定剂量或按需给药方案使用羟考酮相比，门诊ACL手术后立即使用CR羟考酮能提供更有效的镇痛，且镇静、睡眠障碍和术后呕吐更少。
对于接受门诊前交叉韧带修复手术的患者，与固定剂量或按需使用羟考酮方案相比，羟考酮控释制剂具有显著的镇痛益处且副作用更少。
