Anesth Pain Med.  2018 Oct;13(4):394-400. 10.17085/apm.2018.13.4.394.

Comparison of the analgesic efficacy of oxycodone and fentanyl after dental surgery

• Lee JE
• Park CR
• Park SS

• KMID: 2435997
• DOI: http://doi.org/10.17085/apm.2018.13.4.394

Abstract

BACKGROUND
Oxycodone is a strong m-opioid receptor agonist and has a longer duration of analgesic effect than fentanyl. We compared the use of an intravenous (IV) bolus of oxycodone and fentanyl for postoperative analgesic efficacy after dental surgery.
METHODS
Patients underwent surgical extraction under general anesthesia. We prospectively enrolled patients who had received IV oxycodone (n = 36, 0.05 mg/kg) and fentanyl (n = 36, 1 mg/kg) 10 minutes before the end of surgery. The recovery profiles (hemodynamic variables, pain score, postoperative nausea and vomiting, sedation scale, and adverse events) were recorded for 1 hour in the post-anesthetic care unit (PACU) and at 6 hours after surgery.
RESULTS
Under a potency ratio of 50:1 (oxycodone:fentanyl), time to spontaneous ventilation was significantly longer in the oxycodone group (8.1 ± 2.8 min vs. 6.9 ± 1.8 min, P = 0.021). The overall pain scores were significantly lower in the oxycodone than in the fentanyl group (P < 0.001), and the oxycodone group had significantly fewer additional analgesic requirements in the PACU than the fentanyl group (8.3% vs. 27.8%, P = 0.032). The incidence of postoperative nausea and sedation were comparable in both groups. No opioid-related adverse event was identified.
CONCLUSIONS
In dental surgery, 0.05 mg/kg IV oxycodone had a longer-lasting analgesic effect than that of 1 µg/kg IV fentanyl, and could reduce total opioid consumption without increasing side effects. Patients experienced satisfactory analgesia postoperatively; thus, oxycodone is an effective opioid analgesic for acute postoperative pain relief.

Keyword

Acute pain; Fentanyl; Oxycodone; Postoperative pain

MeSH Terms

Acute Pain
Analgesia
Anesthesia, General
Fentanyl*
Humans
Incidence
Oxycodone*
Pain, Postoperative
Postoperative Nausea and Vomiting
Prospective Studies
Ventilation
Fentanyl
Oxycodone

Figure

• 

  Fig. 1 Comparison of postoperative pain. Data are expressed as mean ± SD. Group F: fentanyl group, Group O: oxycodone group. VAS: visual analogue scale, PACU: post-anesthetic care unit. *P < 0.05 compared with Group O; VAS scores at each time point were compared using t-test.

• 

  Fig. 2 Changes in hemodynamic variables. Data are expressed as mean − SD in group F and mean + SD in group O. Group F: fentanyl group, Group O: oxycodone group. Initial: arrival in the operation room, 0, 30, 60 min: minutes after arrival in the post-anesthetic care unit.

Reference

REFERENCE

1. McQuay H. Opioids in pain management. Lancet. 1999; 353:2229–32. DOI: 10.1016/S0140-6736(99)03528-X.

2. Raeder J. Opioids in the treatment of postoperative pain:old drugs with new options? Expert Opin Pharmacother. 2014; 15:449–52. DOI: 10.1517/14656566.2014.879292. PMID: 24437530.

3. Koch S, Ahlburg P, Spangsberg N, Brock B, Tønnesen E, Nikolajsen L. Oxycodone vs. fentanyl in the treatment of early post-operative pain after laparoscopic cholecystectomy:a randomised double-blind study. Acta Anaesthesiol Scand. 2008; 52:845–50. DOI: 10.1111/j.1399-6576.2008.01643.x. PMID: 18477082.

4. Park JH, Lee C, Shin Y, An JH, Ban JS, Lee JH. Comparison of oxycodone and fentanyl for postoperative patient-controlled analgesia after laparoscopic gynecological surgery. Korean J Anesthesiol. 2015; 68:153–8. DOI: 10.4097/kjae.2015.68.2.153. PMID: 25844134. PMCID: PMC4384403.

5. Bodian CA, Freedman G, Hossain S, Eisenkraft JB, Beilin Y. The visual analog scale for pain:clinical significance in postoperative patients. Anesthesiology. 2001; 95:1356–61. DOI: 10.1097/00000542-200112000-00013. PMID: 11748392.

6. Choi YJ, Park SW, Kwon HJ, Choi JM, Lee YM. Efficacy of early intravenous bolus oxycodone or fentanyl in emergence from general anaesthesia and postoperative analgesia following laparoscopic cholecystectomy:a randomized trial. J Int Med Res. 2015; 43:809–18. DOI: 10.1177/0300060515594194. PMID: 26378067.

7. Choi BM. A new therapeutic option for postoperative pain management with oxycodone HCI injection. Korean J Anesthesiol. 2016; 69:211–8. DOI: 10.4097/kjae.2016.69.3.211. PMID: 27274364. PMCID: PMC4891531.

8. Hwang BY, Kwon JY, Kim E, Lee DW, Kim TK, Kim HK. Oxycodone vs. fentanyl patient-controlled analgesia after laparoscopic cholecystectomy. Int J Med Sci. 2014; 11:658–62. DOI: 10.7150/ijms.8331. PMID: 24843313. PMCID: PMC4025163.

9. Urquhart E. Analgesic agents and strategies in the dental pain model. J Dent. 1994; 22:336–41. DOI: 10.1016/0300-5712(94)90084-1.

10. Litkowski LJ, Christensen SE, Adamson DN, Van Dyke T, Han SH, Newman KB. Analgesic efficacy and tolerability of oxycodone 5 mg/ibuprofen 400 mg compared with those of oxycodone 5 mg/acetaminophen 325 mg and hydrocodone 7.5 mg/acetaminophen 500 mg in patients with moderate to severe postoperative pain:a randomized, double-blind, placebo-controlled, single-dose, parallel-group study in a dental pain model. Clin Ther. 2005; 27:418–29. DOI: 10.1016/j.clinthera.2005.04.010. PMID: 15922815.

11. Averbuch M, Katzper M. Baseline pain and response to analgesic medications in the postsurgery dental pain model. J Clin Pharmacol. 2000; 40:133–7. DOI: 10.1177/00912700022008775. PMID: 10664918.

12. Minami K, Hasegawa M, Ito H, Nakamura A, Tomii T, Matsumoto M, et al. Morphine, oxycodone, and fentanyl exhibit different analgesic profiles in mouse pain models. J Pharmacol Sci. 2009; 111:60–72. DOI: 10.1254/jphs.09139FP. PMID: 19729873.

13. Kalso E. Oxycodone. J Pain Symptom Manage. 2005; 29:S47–56. DOI: 10.1016/j.jpainsymman.2005.01.010. PMID: 15907646.