Oxycodone is safe and effective for general anesthesia

Stefan Wirz, PhD, MD; Richard K. Ellerkmann, PhD, MD; Martin Soehle, PhD, MD; Christian-Dieter Wirtz, MD

doi:10.5055/jom.2018.0439

Authors

Stefan Wirz, PhD, MD
Richard K. Ellerkmann, PhD, MD
Martin Soehle, PhD, MD
Christian-Dieter Wirtz, MD

DOI:

https://doi.org/10.5055/jom.2018.0439

Keywords:

oxycodone, perioperative, acute pain therapy, hemodynamics, anesthesia

Abstract

Purpose: In clinical practice, using different opioid analgesics is common during the induction and maintenance of general anesthesia and for postoperative analgesia. However, if the opioid analgesic could be limited to a single drug, we hypothesized that the risk of adverse drug interactions could be reduced, with fewer adverse effects. We examined the use of oxycodone as a single opioid in a well-defined cohort of orthopedic patients undergoing general anesthesia.

Methods: In this retrolective, monocentric investigation, we reviewed data from 83 patients who underwent general anesthesia and received intravenous oxycodone as the sole analgesic (0.075 mg/kg during induction and 0.05 mg/kg during maintenance). The use of oxycodone during general anesthesia and the postoperative pain scores were recorded. Safety was evaluated by the measurement of hemodynamic changes (blood pressure, heart rate), the detection of pathologic changes in the electrocardiogram, changes of the peripheral oxygen saturation, and by the assessment of adverse effects.

Results: There was no significant change in peripheral oxygen saturation or the electrocardiogram during or while recovering from general anesthesia. Heart rate changed only slightly from reversal to recovery (73.3/min versus 78.3/min, p < 0.05) and from prior intubation to recovery (72.5/min versus 78.3/min, p < 0.05). Systolic and diastolic blood pressure did not change significantly from the time points “after intubation” to “after incision,” and “during recovery.” Fifty-nine percent (n = 49) of patients’ records revealed pain scores with a maximum of 3 on a numeric rating scale (NRS) of 0 to10 during the postoperative period. In 45 percent of patients (n = 37), further analgesics such as acetaminophen, dipyrone, or additional doses of oxycodone were used. No severe adverse events were recorded. According to data from 93 percent of patients (n = 77), nausea scores were less than 3 on a NRS of 0 to 10.

Conclusion: Oxycodone can be used as the sole opioid in orthopedic surgery with good intra- and postoperative efficacy and safety; ie, without clinically relevant changes in hemodynamic and respiratory parameters.

Author Biographies

Stefan Wirz, PhD, MD

CURA-Hospital, Department of Anesthesia, Intensive Medicine, Pain Medicine/Palliative Medicine; Center for Pain Medicine, Bad Honnef, Germany

Richard K. Ellerkmann, PhD, MD

Clinic and Policlinic for Anesthesiology and Operative Intensive Medicine, Rheinische Friedrich-Wilhelms-Universität, Bonn, Germany

Martin Soehle, PhD, MD

Clinic and Policlinic for Anesthesiology and Operative Intensive Medicine, Rheinische Friedrich-Wilhelms-Universität, Bonn, Germany

Christian-Dieter Wirtz, MD

Clinic for Orthopaedics and Trauma Surgery, Rheinische Friedrich-Wilhelms-Universität, Bonn, Germany

References

Nielsen CK, Ross FB, Lotfipour S, et al.: Oxycodone and morphine have distinctly different pharmacological profiles: Radioligand binding and behavioural studies in two rat models of neuropathic pain. Pain. 2007; 132: 289-300.

Kalso E: Oxycodone. J Pain Symptom Manage. 2005; 29(suppl 5): 47-56

Lenz H, Sandvik L, Qvigstad E, et al.: A comparison of intravenous oxycodone and intravenous morphine in patient-controlled postoperative analgesia after laparoscopic hysterectomy. Anesth Analg. 2009; 109: 1279-1283.

Kalso E, Vainio A: Morphine and oxycodone hydrochloride in the management of cancer pain. Clin Pharmacol Ther. 1990; 47: 639-646.

Cheville A, Chen A, Oster G, et al.: A randomized trial of controlled-release oxycodone during inpatient rehabilitation following unilateral total knee arthroplasty. J Bone Joint Surg Am. 2001; 83-A(4): 572-576.

Heiskanen T, Kalso E: Controlled-release oxycodone and morphine in cancer related pain. Pain. 1997; 73: 37-45.

Bruera E, Belzile M, Pituskin E, et al.: Randomized, double-blind, cross-over trial comparing safety and efficacy of oral controlled-release oxycodone with controlled-release morphine in patients with cancer pain. J Clin Oncol. 1998; 16: 3222-3229.

Kampe S, Warm M, Kaufmann J, et al.: Clinical efficacy of controlled-release oxycodone 20 mg administered on a 12-h dosing schedule on the management of postoperative pain after breast surgery for cancer. Curr Med Res Opin. 2004; 20: 199-202.

Silvasti M, Rosenberg P, Seppälä T, et al.: Comparison of analgesic efficacy of oxycodone and morphine in postoperative intravenous patient-controlled analgesia. Acta Anaesthesiol Scand. 1998; 42: 576-580.

Marrett E, Kwong WJ, Frech F, et al.: Healthcare utilization and costs associated with nausea and vomiting in patients receiving oral immediate-release opioids for outpatient acute pain management. Pain Ther. 2016; 5(2): 215-226.

Wang N, Wang Y, Pang L, et al.: Effect of preemptive analgesia with intravenous oxycodone in the patients undergoing laparoscopic resection of ovarian tumor. Pak J Med Sci. 2015; 31: 300-303.

Wang J, Pang L, Han W, et al.: Effect of preemptive intravenous oxycodone on low-dose bupivacaine spinal anaesthesia with intrathecal sufentanil. Saudi Med J. 2015; 36: 437-441.

Stamer UM, Zhang L, Book M, et al.: CYP2D6 genotype dependent oxycodone metabolism in postoperative patients. PLoS One; 2013: 8(3): e60239.

Kalso E, Pöyhiä R, Onnela P, et al.: Intravenous morphine and oxycodone for pain after abdominal surgery. Acta Anaesthesiol Scand. 1991; 35: 642-646.

Silvasti M, Tarkkila P, Tuominen M, et al.: Efficacy and side effects of tramadol versus oxycodone for patient-controlled analgesia after maxillofacial surgery. Eur J Anaesthesiol. 1999; 16: 834-839.

Pöyhiä R, Hynynen M, Seppälä T, et al.: Pharmacodynamics and pharmacokinetics of high-dose oxycodone infusion during and after coronary artery bypass grafting. J Cardiothorac Vasc Anesth. 2004; 18: 748-754.

Mattila MAK, Ahlström-Bengs E, Pekkola P: Intravenous indomethacin or oxycodone in prevention of postoperative pain. BMJ. 1983; 287: 1028.

Lugo RA, Kern SE: The pharmacokinetics of oxycodone. J Pain Palliat Care Pharmacother. 2004; 18: 17-30.

Ordoñez Gallego A, González Barón M, Espinosa Arranz E: Oxycodone: A pharmacological and clinical review. Clin Transl Oncol. 2007; 9: 298-307.

de Beer J de V, Winemaker MJ, Donnelly GA, et al.: Efficacy and safety of controlled-release oxycodone and standard therapies for postoperative pain after knee or hip replacement. Can J Surg. 2005; 48: 277-283.

Benthuysen JL, Smith NT, Sanford TJ et al.: Physiology of alfentanil-induced rigidity. Anesthesiology. 1986; 64: 440-446.

Chang J, Fish KJ: Acute respiratory arrest and rigidity after anaesthesia with sufentanil: A case report. Anesthesiology. 1985; 63: 710-711.

Sokoll MD, Hoyt JL, Georgis SD: Studies in muscle rigidity, nitrous oxide and narcotic analgesic agents. Anesth Analg. 1972; 51: 16-20.

de Baerdemaeker LE, Jacobs S, Pattyn P, et al.: Influence of intraoperative opioid on postoperative pain and pulmonary function after laparoscopic gastric banding: remifentanil TCI vs sufentanil TCI in morbid obesity. Br J Anaesth. 2007; 99: 404-411.

Weber L, Yeomans DC, Tzabazis A: Opioid-induced hyperalgesia in clinical anesthesia practice: What has remained from theoretical concepts and experimental studies? Curr Opin Anaesthesiol. 2017; 30(4): 458-465.