Intravenous Oxycodone Versus Other Intravenous Strong Opioids for Acute Postoperative Pain Control: A Systematic Review of Randomized Controlled Trials.

INTRODUCTION: Optimal pain management is crucial to the postoperative recovery process. We aimed to evaluate the efficacy and safety of intravenous oxycodone with intravenous fentanyl, morphine, sufentanil, pethidine, and hydromorphone for acute postoperative pain. METHODS: A systematic literature search of PubMed, Cochrane Library, and EMBASE databases was performed for randomized controlled trials published from 2008 through 2017 (inclusive) that evaluated the acute postoperative analgesic efficacy of intravenous oxycodone against fentanyl, morphine, sufentanil, pethidine, and hydromorphone in adult patients (age ≥ 18 years). Outcomes examined included analgesic consumption, pain intensity levels, side effects, and patient satisfaction. RESULTS: Eleven studies were included in the review; six compared oxycodone with fentanyl, two compared oxycodone with morphine, and three compared oxycodone with sufentanil. There were no eligible studies comparing oxycodone with pethidine or hydromorphone. Overall, analgesic consumption was lower with oxycodone than with fentanyl or sufentanil. Oxycodone exhibited better analgesic efficacy than fentanyl and sufentanil, and comparable analgesic efficacy to morphine. In terms of safety, there was a tendency towards more side effects with oxycodone than with fentanyl, but the incidence of side effects with oxycodone was comparable to morphine and sufentanil. Where patient satisfaction was evaluated, higher satisfaction levels were observed with oxycodone than with sufentanil and comparable satisfaction was noted when comparing oxycodone with fentanyl. Patient satisfaction was not evaluated in the studies comparing oxycodone with morphine. CONCLUSIONS: Our findings suggest that intravenous oxycodone provides better analgesic efficacy than fentanyl and sufentanil, and comparable efficacy to morphine with less adverse events such as sedation. No studies comparing intravenous oxycodone with pethidine or hydromorphone were identified in this review. Better alignment of study methodologies for future research in this area is recommended to provide the best evidence base for a meta-analysis. FUNDING: Mundipharma Singapore Holding Pte Ltd, Singapore.

Dexmedetomidine as part of a balanced anesthesia and the use of the proseal LMA in a patient with osteogenesis imperfecta for abdominal hysterectomy: a case report

Osteogenesis imperfecta is an inherited disorder of collagen with skeletal and extraskeletal manifestations that affect airway and anesthetic management of patients with the disease. This paper aimed to report a case of a patient with osteogenesis imperfecta for abdominal hysterectomy, discuss the anesthetic considerations of patients with the disease, describe balanced anesthesia using high dose dexmedetomidine as a primary agent and, use of ProSeal LMA for airway management. A 44- year old female with osteogenesis imperfecta is scheduled for abdominal hysterectomy for molar pregnancy. Airway management was achieved with a ProSeal LMA, and surgery was conducted using balanced anesthesia with high dose dexmedetomidine, midazolam, fentanyl, atracurium and O2- nitrous oxide. Dexmedetomidine was given at concentrations ranging from 0.7 mcg/kg/hr to 3mcg/kg/hr without untoward adverse effects. No complications were observed intraoperatively and in the immediate postoperative period. Dexmedetomidine is demonstrated to be safe and effective when used as part of a balanced anesthesia for patients with osteogenesis imperfecta. Likewise, the airway can be reliably managed with the use of a ProSeal LMA.