Patient-controlled analgesia versus oral controlled-release oxycodone - are they interchangeable for acute postoperative pain after laparoscopic colorectal surgeries?

BACKGROUND: Standard therapy for postoperative pain after laparoscopic colorectal surgeries at the Tan Tock Seng Hospital consists of intravenous morphine via patient-controlled analgesia (PCA) for the first 24-48 h, followed by oral analgesics. We compared the efficacy and safety of oral controlled-release (CR) oxycodone hydrochloride (OxyContin tablets) and PCA after laparoscopic colorectal surgeries. METHODS: Between March and August 2006 (phase 1 study), 14 patients underwent laparoscopic colectomy, laparoscopic hemicolectomy or laparoscopic-assisted anterior resections. All patients were on oral CR oxycodone with oral immediate-release oxycodone on an as-needed basis for breakthrough pain. Pain intensity, analgesic use, length of hospital stay and side effects were evaluated. These were compared to data obtained from a second study of a similar design where 9 patients underwent similar operations from October 2006 to July 2007 (phase 2 study) and were on PCA morphine. RESULTS: All patients in the CR oxycodone and PCA morphine groups needed the opioid medication for only 2 days. There was no difference in mean (range) postoperative pain intensity scores between patients on oxycodone and those on PCA morphine for the 1st postoperative day [2.07 (0-5) vs. 2.78 (2-4) on a Visual Analogue Scale (VAS) from 0 to 10; p = 0.10] and the 2nd postoperative day [1.14 (0-2) vs. 1.67 (0-3); p = 0.10]. Generalized estimating equations with linear link function confirmed that there was a significant relief of pain in patients after operation. On average, the VAS score of pain was 1.00 units lower on day 2 when compared with day 1 (p < 0.01). The mean (range) doses of oxycodone used on the 1st and 2nd postoperative day were 13.57 mg (10-30) and 15.36 mg (10-30), and the mean (range) doses of morphine used on the 1st and 2nd postoperative day were 14.9 mg (8-28) and 16.3 mg (4-31), respectively. Incidence of nausea and vomiting was 14.2 and 20% for the CR oxycodone and PCA groups, respectively. CONCLUSIONS: Oral CR oxycodone 20 mg per day is a cheaper, convenient and an efficacious alternative analgesic to PCA opioids after laparoscopic colorectal surgery.

Anaesthetic management of awake craniotomy for tumour resection.

INTRODUCTION: Awake craniotomy allows accurate localisation of the eloquent brain, which is crucial during brain tumour resection in order to minimise risk of neurologic injury. The role of the anaesthesiologist is to provide adequate analgesia and sedation while maintaining ventilation and haemodynamic stability in an awake patient who needs to be cooperative during neurological testing. We reviewed the anaesthetic management of patients undergoing an awake craniotomy procedure. MATERIALS AND METHODS: The records of all the patients who had an awake craniotomy at our institution from July 2004 till June 2006 were reviewed. The anaesthesia techniques and management were examined. The perioperative complications and the outcome of the patients were noted. RESULTS: There were 17 procedures carried out during the study period. Local anaesthesia with moderate to deep sedation was the technique used in all the patients. Respiratory complications occurred in 24% of the patients. Hypertension was observed in 24% of the patients. All the complications were transient and easily treated. During cortical stimulation, motor function was assessed in 16 patients (94%). Three patients (16%) had lesions in the temporal-parietal region and speech was assessed intraoperatively. Postoperative motor weakness was seen in 1 patient despite uneventful intraoperative testing. No patient required intensive care unit stay. The median length of stay in the high dependency unit was 1 day and the median length of hospital stay was 9 days. There was no in-hospital mortality. CONCLUSION: Awake craniotomy for brain tumour excision can be successfully performed under good anaesthetic conditions with careful titration of sedation. Our series showed it to be a well-tolerated procedure with a low rate of complications. The benefits of maximal tumour excision can be achieved, leading to potentially better patient outcome.