Analgesic Efficacy and Safety of Spinal Oxycodone in Total Hip Arthroplasty: A Preliminary Study.

Abstract

AIM:

The aim of this study was to assess the analgesic efficacy and safety of 1 mg and 0.5 mg oxycodone administration in a spinal block procedure for a total hip arthroplasty (THA).

PATIENTS AND METHODS:

Forty-two THA patients aged 59-81 with American Society Anesthesiology (ASA) II-III were included. All patients received anesthesia using spinal blockade, with bupivacaine 0.5% spinal heavy 2.5 ml, with 0.5 ml oxycodone hydrochloride 1.0 mg (group A; n = 28) or 0.5 mg (group B; n = 14). During surgery, each patient was sedated with 2-4 mg/kg/h intravenous propofol infusion. They received 100 mg intravenous ketoprofen at the end of the surgery at 8 pm and 8 am, with recommended doses every 12 h thereafter. Subcutaneous morphine 5 mg was used as a rescue analgesic, and the time to morphine use was recorded. After surgery, pain intensity (at the moment of patient report) was assessed using an 11-point numerical rating scale (NRS). The incidence of adverse effects was monitored. Blood samples were taken for assays of serum oxycodone, noroxycodone and bupivacaine levels.

RESULTS:

The time to rescue analgesia was 9.6 ± 5.6 h in group A and 7.3 ± 1.9 h in group B, and it did not differ between patient groups (P = 0.179). The mean NRS pain score was 4.5 in group A and 4.2 in group B. Three group A patients had detectable oxycodone levels: two < 7.1 ng/ml and in 1 spinal block induced anesthesia was unsuccessful and so he/she underwent general anesthesia (this patient was excluded from the analysis). Four group B patients had single values < 5 ng/ml. Noroxycodone levels were in all patients undetectable, and bupivacaine levels were 70-300 ng/ml. Regarding adverse effects, one patient had hypotension, one had bradycardia, and one had pruritus.

CONCLUSION:

Oxycodone in spinal block prolongs analgesia period, does not cause serious adverse effects and seems to be safe and effective opioid for patients undergoing THA.

• Authors: Grzegorz Kowalski, Bogumił Olczak, Wojciech Leppert, Agnieszka Bienert, Artur Teżyk, Danuta Szkutnik-Fiedler, Michał Adamski, Katarzyna Wieczorowska-Tobis
• Journal: Current medicinal chemistry (Curr Med Chem) Vol. 29 Issue 21 Pg. 3806-3814 ( 2022) ISSN: 1875-533X [Electronic] United Arab Emirates
• PMID: 35081884 (Publication Type: Journal Article)
• Copyright: Copyright© Bentham Science Publishers; For any queries, please email at [email protected].

Chemical References

• Analgesics, Opioid
• Morphine
• Oxycodone
• Bupivacaine

Topics

• Analgesics, Opioid (adverse effects)
• Arthroplasty, Replacement, Hip (adverse effects)
• Bupivacaine (therapeutic use)
• Double-Blind Method
• Female
• Humans
• Morphine (therapeutic use)
• Oxycodone (adverse effects)
• Pain, Postoperative (chemically induced, drug therapy)