Comparison of oxycodone and fentanyl for postoperative patient-controlled analgesia after orthopedic surgery

BACKGROUND: Oxycodone is widely used as bolus or patient-controlled analgesia (PCA) for control of postoperative pain. The aim of this study was to assess the efficacy and side effects of oxycodone for somatic pain by comparing oxycodone and fentanyl intravenous PCA after orthopedic surgery. METHODS: Seventy-three patients undergoing orthopedic surgery were randomly assigned to receive fentanyl or oxycodone using intravenous PCA (potency ratio 1:60). Pain severity at rest and with movement and adverse effects were assessed at 1, 6, 24, and 48 hours after surgery. The PCA dose and patient satisfaction scores were measured at 48 hours after surgery. RESULTS: The resting visual analogue scale (VAS) and moving VAS scores of the oxycodone group were significantly higher than those of the fentanyl group at 6 hours (P = 0.001, P = 0.021), but at 48 hours, the resting and moving VAS of the oxycodone group were significantly lower than those of the fentanyl group (P = 0.014, P = 0.037). There were no significant differences in adverse effects, satisfaction scores, dose of patient-controlled mode, or total cumulative PCA dose. CONCLUSIONS: With a 1:60 ratio of oxycodone to fentanyl when using PCA for pain control after orthopedic surgery, the use of larger doses of oxycodone for 6 hours is effective in controlling early postoperative pain.

Tecnica mínimamente invasiva (MIPO) y síntesis por vía anterior para el tratamiento de las fracturas diafisarias del húmero / Minimally invasive technique (MIPO) and synthesis by anterior approach for the treatment of humeral shaft fractures

El objetivo del trabajo es evaluar los resultados clínicos, funcionales y radiográficos en el tratamiento con cirugía mínimamente invasiva (MIPO) para las fracturas de la diáfisis humeral, el trabajo fue diseñado bajo la modalidad de serie clínica, del tipo prospectivo, realizado en el Hospital Coromoto durante diciembre del 2007 a enero del 2009, con una población de 11 fracturas de la diáfisis humeral, a los cuales se les realizó técnica MIPO con placas LCP de 4,5 fijada en la anterior de la diáfisis humeral, los resultados se manejaron de acuerdo a las escuelas de valoración de la UCLA para el hombro y de la Clínica de Mayo para el codo (MEPS), obteniendo 82 por ciento de excelentes y 18 por ciento de buenos resultados según la escala de la UCLA, y 73 por ciento de excelentes y 27 por ciento de buenos resultados según la escala MEPS, no se obtuvieron resultados regulares y/o malos tampoco lesiones iatrogénicas del N. radial, no hubo revisiones quirúrgicas ni casos de seudoartrosis, tampoco fallas del implante. La cirugía MIPO es una alternativa segura y eficaz que se corresponde con los nuevos conceptos biológicos.

Evaluate clinical outcomes, functional and radiological treatment minimally invasive surgery (MIPO) for fractures of the humeral diaphysis, the work was designed in the form of clinical series, conducted in a prospective Coromoto Hospital during december 2007 to january 2009, with a population of 11 fractures of the humeral diaphysis, which plate LCP 4.5 set in the front of the humeral diaphysis, the results will be handled according to the assessment scales at UCLA for the men the Mayo Clinic for the elbow, getting 82 percent and 18 percent excellent success according to the scale of UCLA an 73 percent excellent and 27 percent of good performance as the scale of the Mayo Clinic, were not iatrogenic injuries of the N. radio, there was no case of surgical revisions pseudoarthrosis or failure of the implant. Minimally invasive surgery for percutaneous techniques is a safe and effective alternative tha corresponds to new biological concepts.