Cheung Chi Wai, Ching Wong Stanley Sau, Qiu Qiu, Wang Xianyu
Laboratory and Clinical Research Institute for Pain, Dept of Anesthesiology, The University of Hong Kong.
Dept of Anesthesiology, Taihe Hospital, Hubei University of Medicine.
Pain Physician. 2017 Feb;20(2S):SE33-SE52.
Opioids are the mainstay of pain management for acute postsurgical pain. Oral oxycodone is an opioid that can provide effective acute postoperative pain relief.
To evaluate the use of oral oxycodone for acute postoperative pain management.
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.
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 "post-operative." Treatment interventions were compared for analgesic efficacy, rescue medication use, side effects, recovery, length of hospital stay, and patient satisfaction.
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 (withdrawn from the US market due to cardiac safety concerns).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.
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.
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.
阿片类药物是术后急性疼痛管理的主要手段。口服羟考酮是一种能够有效缓解术后急性疼痛的阿片类药物。
评估口服羟考酮用于术后急性疼痛管理的效果。
这是一项叙述性综述，基于2003年至2015年在PubMed和Medline上检索到的关于口服羟考酮用于术后急性疼痛管理的已发表文章。
通过PubMed和Medline检索2003年至2015年期间与口服羟考酮用于术后急性疼痛管理相关的临床试验。使用的检索词为“口服强效阿片类药物”“手术后的”“术后的”“外科手术后的”和“手术后的”。比较了治疗干预措施在镇痛效果、急救药物使用、副作用、恢复情况、住院时间和患者满意度方面的差异。
该综述纳入了26项临床试验。在接受腹腔镜胆囊切除术、腹部或盆腔手术、拇囊炎切除术、乳腺手术和脊柱手术的患者中，口服羟考酮与安慰剂相比显示出更好的术后镇痛效果。与静脉注射阿片类药物相比，口服羟考酮在膝关节置换术、脊柱手术、剖宫产、腹腔镜结直肠手术和心脏手术后提供了更好或相当的疼痛缓解效果。一项关于牙科手术后疼痛的研究报告称，口服羟考酮的疼痛控制效果不如罗非昔布（因心脏安全问题已从美国市场撤出）。在许多研究中，羟考酮治疗组的急救镇痛需求和阿片类药物总消耗量有所减少。与使用其他阿片类药物的患者相比，接受口服羟考酮的患者出现的阿片类药物相关副作用更少，术后恶心和呕吐的发生率与使用安慰剂的患者相似。此外，与硬膜外和静脉注射镇痛药相比，口服羟考酮不会延长住院时间，且药物成本更低。作为多模式镇痛方案的一部分使用羟考酮可产生更好的疼痛缓解效果，副作用更少，住院时间缩短。
个别外科手术的随机双盲研究数量有限，因此更难得出确切结论。
口服羟考酮似乎能提供安全有效的术后镇痛，是标准静脉注射阿片类镇痛药的一种广泛接受且合理的替代药物。关键词：术后；疼痛；镇痛；口服羟考酮；阿片类药物
