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OBJECTIVE@#To observe the clinical efficacy of Miao medicinal crossbow acupuncture therapy as adjuvant treatment for lung cancer pain based on oxycodone hydrochloride extended-release tablet.@*METHODS@#A total of 60 patients with lung cancer pain were randomized into an observation group (30 cases, 1 case dropped off) and a control group (30 cases). In the control group, oxycodone hydrochloride extended-release tablet was given orally, 10 mg a time, once every 12 hours. On the basis of the treatment in the control group, Miao medicinal crossbow acupuncture therapy was applied once every other day in the observation group. The treatment of 14 days was required in the two groups. Before and after treatment, the numerical rating scale (NRS) score, number of break-out pain and Karnofsky performance status (KPS) score were observed in the two groups. The equivalent oxycodone consumption and rate of adverse reactions were recorded, the analgesic effect was evaluated in the two groups.@*RESULTS@#Compared before treatment, the NRS scores and number of break-out pain were decreased while the KPS scores were increased after treatment in the two groups (P<0.01). After treatment, the NRS score and number of break-out pain in the observation group were lower than the control group (P<0.01), the KPS score in the observation group was higher than the control group (P<0.05). The equivalent oxycodone consumption of whole course and the rate of adverse reactions i.e. constipation, drowsiness, nausea and vomiting in the observation group were lower than the control group (P<0.05). The analgesic effect rate was 93.1% (27/29) in the observation group, which was superior to 63.3% (19/30) in the control group (P<0.05).@*CONCLUSION@#On the basis of oxycodone hydrochloride extended-release tablet, Miao medicinal crossbow acupuncture therapy as adjuvant treatment can effectively relieve the pain degree, reduce the number of break-out pain and improve the health status and quality of life in patients with lung cancer pain, enhance the efficacy of medication and reduce its adverse reactions.
الموضوعات
Humans , Cancer Pain , Oxycodone , Quality of Life , Lung Neoplasms , Pain , Acupuncture Therapy , Adjuvants, Immunologic , Lung , Analgesicsالملخص
Objective:To retrospectively observe the effect of oxycodone on acute postoperative pain in patients undergoing thoracoscopic surgery.Methods:A retrospective analysis was conducted on the clinical data of 404 patients undergoing thoracoscopic thoracic surgery under combined general anesthesia at the Xiangya Hospital, Central South University from April 1, 2020 to September 30, 2021. They were divided into A group ( n=99, oxycodone group) and B group ( n=305, control group) based on whether oxycodone was used during the surgery. The two groups of patients were further matched 1∶1 using the nearest neighbor matching method. We compared the Visual Analogue Scale (VAS) of activity and resting pain and the incidence of moderate to severe pain between two groups of patients 24 hours after surgery, and observed the incidence and severity of pain related adverse reactions such as nausea, vomiting, itching, and dizziness. Resultsl:After matching the propensity scores of the two groups of patients, the balance was good ( SMD<0.20). There was no statistically significant difference between the groups in age, gender, body mass index, American Society of Anesthesiologist (ASA) grade, surgical time, intraoperative bleeding, and the use of antiemetics and analgesics during the perioperative period (all P>0.05). Compared with the control group, patients in the group A had a resting VAS [(2.03±1.61)points vs (1.62±1.31)points, P=0.049], and activity VAS [(4.13±1.72)points vs (3.51±1.79)points, P=0.013] was even lower, and the incidence of moderate to severe pain (VAS≥4) during activity was lower [59.6%(59/99) vs 37.4%(37/99), P=0.003]. There was no statistically significant difference in the incidence of analgesic related adverse reactions between the two groups ( P>0.05). Conclusions:Intravenous injection of oxycodone can effectively alleviate acute pain in patients undergoing thoracoscopic surgery within 24 hours, and reduce the incidence of moderate to severe pain during activity.
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Objective To explore the effect of oxycodone hydrochloride on inflammation and neuro-nal apoptosis in epileptic rats through c-Jun amino terminal kinase(JNK)/p38 mitogen activated protein kinase(p38 MAPK)signaling pathway.Methods After epileptic rat model was success-fully constructed,72 epileptic rats were randomly divided into model group,low-,medium-and high-dose oxycodone hydrochloride groups(0.125,0.25 and 0.5 mg/kg),anisomycin(JNK activa-tor 5 mg/kg)and combined group(0.5 mg/kg oxycodone hydrochloride+5 mg/kg anisomycin),with 12 rats in each group.Another 12 healthy rats were selected as control group.In 24 h after the end of administration,the frequency and duration of seizures were recorded for all rats.ELISA was used to detect the serum levels of TNF-α and IL-6,HE staining was employed to observe the his-topathological changes in hippocampal CA1 region,and TUNEL staining was applied to detect the apoptosis of CA1 region neurons.The expression of JNK,p-JNK,p38 MAPK,p-p38 MAPK and Caspase-3 in hippocampal CA1 region was detected by Western blotting.Results Compared with the rats from the control group,those of the model group showed higher frequency and longer du-ration of seizures,higher serum TNF-α and IL-6 levels,increased apoptotic rate of hippocampal CA1 neurons,and elevated p-JNK/JNK ratio,p-p38 MAPK/p38 MAPK ratio and Caspase-3 expression(P＜0.05).While low-,medium-and high-dose oxycodone hydrochloride treatment re-versed above changes in frequency and duration of seizures,serum TNF-α and IL-6 levels,neuro-nal apoptosis,p-JNK/JNK ratio,p-p38 MAPK/p38 MAPK ratio and Caspase-3 expression(P＜0.05).In the anisomycin group,higher frequency and longer duration of seizures,elevated serum TNF-α and IL-6 levels,increased neuronal apoptotic rate in hippocampal CA1 region,and en-hanced p-JNK/JNK ratio,p-p38 MAPK/p38 MAPK ratio and Caspase-3 expression(P＜0.05).Lower frequency and shorter duration of seizures,decreased serum TNF-α and IL-6 levels,and re-duced neuronal apoptotic rate in hippocampal CA1 region were observed in the combined group than the anisomycin group(P＜0.05).The combined group obtained statistically lower p-JNK/JNK ratio,p-p38 MAPK/p38 MAPK ratio and Caspase-3 expression in hippocampal CA1 region than the high-dose group,and opposite results than the anisomycin group(0.89±0.12 vs 0.25± 0.05 vs 1.08±0.16,0.81±0.08 vs 0.21±0.04 vs 0.94±0.12,0.79±0.12 vs 0.26±0.04 vs 0.89± 0.14,P＜0.05).Conclusion Oxycodone hydrochloride can reduce inflammatory response,im-prove epileptic symptoms and pathological damages,and protect neurons in epileptic rats,which is related to the inhibition of JNK/p38 MAPK signaling pathway.
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Objective:To compare the efficacy of dexmedetomidine combined with sufentanil versus oxycodone for percutaneous transforaminal endoscopic surgery. Methods:Eighty patients with lumbar disc herniation undergoing percutaneous transforaminal endoscopic discectomy, aged 18-65 yr, were selected and divided into 2 groups ( n=40 each) according to the random number table method: dexmedetomidine combined with sufentanil group and dexmedetomidine combined with oxycodone group. Dexmedetomidine was given as a loading dose of dexmedetomidine 0.8 μg/kg (10-15 min) before surgery, followed by an intravenous infusion of 0.4-0.6 μg/kg until 10 min before the end of surgery. At 5 min before surgery, sufentanil was intravenously injected as a bolus of 0.1 μg/kg, followed by an intravenous infusion of 0.1 μg/kg until 10 min before the end of surgery in dexmedetomidine combined with sufentanil group, and oxycodone was intravenously injected as a bolus of 0.05 μg/kg, followed by an intravenous infusion of 0.05 mg/kg until 10 min before the end of surgery in dexmedetomidine combined with oxycodone group. The Ramsay sedation score, mean arterial pressure and heart rate were recorded before administration, before skin incision, at 10 min after the start of surgery, at polishing facet joints and at the end of surgery. Bispectral index value was also recorded before skin incision, at 10 min after the start of surgery, at polishing facet joints and at the end of surgery. The emergence time was recorded, and the emergence quality was evaluated using Steward score. The visual analog scale score was recorded before surgery and at 1, 6 and 24 h after surgery. Peripheral venous blood samples were taken before administration and at 1 h after surgery for determination of concentrations of serum angiotensin Ⅱ and endothelin by radioimmunoassay. The perioperative adverse reactions were recorded. Results:Compared with dexmedetomidine combined with sufentanil group, the Ramsay sedation score before skin incision, at 10 min after the start of surgery, at polishing facet joints and at the end of surgery was significantly increased, and the mean arterial pressure, heart rate and bispectral index value were decreased, and the visual analog scale score at each time point after surgery and serum angiotensin Ⅱ and endothelin concentrations at 1 h after surgery were decreased, the incidence of adverse reactions was decreased( P<0.05), and no significant change was found in Steward score and emergence time in dexmedetomidine combined with oxycodone group( P>0.05). Conclusions:Compared with sufentanil, dexmedetomidine combined with oxycodone has a better analgesia efficacy with fewer adverse reactions in the patients undergoing percutaneous transforaminal endoscopic surgery.
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Introduction: In patients receiving opioids, relief of cancer pain by palliative radiation therapy or other means can lead to opioid discontinuation and subsequent withdrawal symptoms, such as agitation, insomnia, and diarrhea, due to opioid-related physical dependence. Appropriate steps should be taken to prevent these symptoms. Case: A 72-year-old man underwent surgery for esophageal cancer. He developed low back pain and right lower limb pain, and was diagnosed with sacral and right iliac bone metastases. His pain was resistant to oxycodone (OXC), so he was simultaneously treated with methadone (MDN) and palliative radiotherapy. His pain gradually decreased, and MDN was tapered and switched to OXC, which was in turn discontinued at 20 mg/day at the patient's strong request. After OXC discontinuation, akathisia, anxiety, and diarrhea appeared as withdrawal symptoms. These were treated with immediate-release OXC, transdermal fentanyl, and suvorexant. Discussion: When discontinuing opioids, dose reduction below 10% per week is recommended, de-escalation to the lowest possible dose should be followed by cessation. In case of withdrawal symptoms, immediate-release opioids may be used, and opioid tapering should be attempted in parallel with symptom control.
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Methods:To investigate the analgesic efficacy of oxycodone after cesarean section and its effects on pain factors.Methods:A total of 100 pregnant women who underwent cesarean section in Taizhou Hospital of Zhejiang Province from August 2022 to March 2023 were included in this prospective study. They were divided into an observation group ( n = 50) and a control group ( n = 50) using a random number table method. Sufentanil was used for postoperative analgesia in the control group, and oxycodone was used for postoperative pain in the observation group. At 6, 12, 24, and 48 hours after surgery, visual analogue scale (VAS) scores of incision pain and uterine contraction pain and the Ramsay score were compared between the two groups. Before and 48 hours after surgery, pain factors (prostaglandin E 2, substance P, and norepinephrine) were compared between the two groups. At 48 hours after surgery, sleep quality, satisfaction with pain relief, and the incidence of adverse reactions were compared between the two groups. Results:The VAS scores of incision pain in the observation group were lower than those in the control group at the studied time points after surgery [6 hours: (2.35 ± 0.31) points vs. (2.78 ± 0.43) points; 12 hours: (5.08 ± 0.64) points vs. (5.67 ± 0.51) points; 24 hours: (4.76 ± 0.35) points vs. (5.12 ± 0.42) points; 48 hours: (2.18 ± 0.37) points vs. (2.54 ± 0.42) points, t = 5.74, 19.87, 4.66, 4.55, all P < 0.001]. At 6, 12, 24, and 48 hours after surgery, the VAS scores of uterine contraction pain in the observation group were significantly lower than those in the control group at the studied time points after surgery [6 hours: (2.41 ± 0.26) points vs. (2.85 ± 0.32) points; 12 hours: (4.98 ± 0.49) points vs. (5.41 ± 0.65) points; 24 hours: (4.65 ± 0.31) points vs. (4.98 ± 0.28) points; 48 hours: (2.04 ± 0.26) points vs. (2.43 ± 0.30) points, t = 7.55, 3.74, 5.59, 6.95, all P < 0.001]. There was no significant difference in Ramsay score between the two groups at 6, 12, 24, and 48 hours after surgery ( t = 0.44, 0.51, 0.78, 0.42, all P > 0.05). At 48 hours after surgery, prostaglandin E 2, substance P, and norepinephrine levels in the observation group were significantly lower than those in the control group ( t = 14.22, 9.05, 14.74, all P < 0.001). At 48 hours after surgery, The Pittsburgh Sleep Quality Index score in the observation group was significantly higher than that in the control group ( t = 4.64, P < 0.05). The overall satisfaction with postpartum analgesia in the observation group was significantly higher than that in the control group ( χ2 = 4.40, P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups ( χ2 = 0.33, 1.08, 0.38, 0.33, all P > 0.05). Conclusion:Oxycodone has a better analgesic effect on cesarean sections than sufentanil. Oxycodone can inhibit the release of pain factors and thereby reduce pain.
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Objective:To compare the recovery effect of continuous infusion of dexmedetomidine combined with oxycodone or sufentanil in the anesthesia intensive care unit (AICU) in elderly patients after thoracoscopic radical surgery for lung cancer.Methods:Using the method of prospective study, 80 elderly lung cancer patients underwent selective thoracoscopic radical surgery under general anesthesia in Nanjing First Hospital from February 2021 to May 2022 were selected. The patients were divided into dexmedetomidine combined with sufentanil group (S group) and dexmedetomidine combined with oxycodone group (Q group) by random digits table method with 40 cases each group. On the basis of routine monitoring and treatment after operation, the patients in Q group were continuously injected with oxycodone 0.03 mg/(kg·h) and dexmedetomidine 0.4 μg/(kg·h) through analgesia pump, the patients in S group were continuously injected with sufentanil 0.03 mg/(kg·h) and dexmedetomidine 0.4 μg/(kg·h) through analgesia pump. The wake-up time, extubation time, awakening quality (Aldrete score and bucking score) and comfort level (Bruggrmann comfort scale score, BCS score) after entering the AICU were record; the sedation score (Ramsay score) and pain relief score (numerical rating scale score, NRS score) and hemodynamic changes (mean arterial pressure and heart rate) 3, 5, 7, 10 and 14 h after entering the AICU were record; the level of serum inflammatory factors, including tumor necrosis factor (TNF-α), interleukin-6 (IL-6) and C-reactive protein (CRP) immediately, 5 h and 14 h after entering the AICU; press times of analgesia pump, adverse events, bleeding volume of drainage tube during AICU and overall satisfaction score when leaving the AICU were record.Results:The bucking score in Q group was significantly lower than that in S group: (1.02 ± 0.77) scores vs. (1.88 ± 0.34) scores, the Aldrete score and BCS score were significantly higher than those in S group: (8.93 ± 0.25) scores vs. (5.97 ± 0.32) scores and (3.03 ± 0.32) scores vs. (0.93 ± 0.52) scores, and there were statistical differences ( P<0.01); there were no statistical difference in wake-up time and extubation time between two groups ( P>0.05). There were no statistical difference Ramassy score, NRS score 3 and 5 h after entering the AICU, mean arterial pressure and heart rate between two groups ( P>0.05); the Ramassy score 7, 10 and 14 h after entering the AICU in Q group was significantly lower than that in S group, the NRS score, mean arterial pressure and heart rate were significantly lower than those in S group, and there were statistical differences ( P<0.01). There were no statistical differences in TNF-α, IL-6 and CRP immediately after entering the AICU between two groups ( P>0.05); the TNF-α, IL-6 and CRP 5 and 14 h after entering the AICU in Q group were significantly lower than those in S group, and there were statistical difference ( P<0.01). The press times of analgesia pump, bleeding volume of drainage tube and the incidences of nausea vomiting, respiratory depression, lethargy, restlessness, fever and lung infection in Q group were significantly lower than those in S group: (4.63 ± 1.10) times vs. (18.80 ± 1.54) times, (129.67 ± 4.14) ml vs. (164.00 ± 8.14) ml, 10.0% (4/40) vs. 52.5% (21/40), 2.5% (1/40) vs. 25.0% (10/40), 7.5% (3/40) vs. 47.5% (19/40), 0 vs. 20.0% (8/40), 2.5% (1/40) vs. 22.5% (9/40) and 2.5% (1/40) vs. 20.0% (8/40), and there were statistical differences ( P<0.01 or <0.05); there was no severe hypotension, severe bradycardia and delirium in both groups. The overall satisfaction score in Q group was significantly higher than that in S group: (3.53 ± 0.63) scores vs. (2.70 ± 0.65) scores, and there was statistical difference ( P<0.01). Conclusions:Continuous micro-pump infusion of dexmedetomidine combined with oxycodone in AICU elderly patients with lung cancer after thoracoscopic radical surgery can significantly improve the quality of recovery and comfort during extubation, without affecting the extubation time, and can effectively reduce the degree of pain, stress and inflammatory reaction in the early recovery period, and reduce the incidence of adverse events after surgery.
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Abstract We aimed to compare the effects of oxycodone hydrochloride and dezocine on hemodynamics and inflammatory factors in patients receiving gynecological laparoscopic surgery under general anesthesia. A total of 246 patients were divided into group A and B (n=123). Hemorheology indices were recorded 5 min after anesthesia (T0), 1 min after pneumoperitoneum (T1), when position was changed 5 min after pneumoperitoneum (T2), 15 min after pneumoperitoneum (T3), 1 min (T4) and 5 min (T5) after position was restored. Visual analogue scale scores 1, 2, 6, 12, 24 and 48 h after operation were recorded. Postoperative adverse reactions and visceral pain were observed. The expression levels of inflammatory factors were detected by enzyme-linked immunosorbent assay 12 h after operation. Compared with group A, group B had higher heart rate and mean arterial pressure at T2, lower central venous pressure and cardiac output at T1-T3, and higher systemic vascular resistance at T1-T5 (P<0.05). The incidence rate of pain syndrome in group A was lower (P<0.05). Group A had lower tumor necrosis factor-alpha and interleukin-6 expression levels and higher interleukin-10 level than those of group B (P<0.05). For gynecological laparoscopic surgery, oxycodone preemptive analgesia has superior outcomes to those of dezocine
الموضوعات
Humans , Female , Adult , Middle Aged , Patients/classification , Laparoscopy/instrumentation , Anesthesia, General/instrumentation , Enzyme-Linked Immunosorbent Assay/methodsالملخص
Objective:To investigate the effects of oxycodone multimodal analgesia on quality of awakening and hemodynamics in patients undergoing laparoscopic gynaecological surgery.Methods:Ninety patients who underwent laparoscopic ovarian cyst removal in Weihai Central Hospital from September 2018 to March 2019 were included in this study. They were randomly divided into observation and control groups, with 45 patients in each group. Both groups were given intravenous flurbiprofen axetil (1 mg/kg) for preemptive analgesia. Combined intravenous and inhalation anesthesia was used. The depth of anesthesia was monitored. The observation group was intravenously given 0.10 mg/kg oxycodone and the control group was intravenously given 5 μg sufentanil. Quality of awakening, hemodynamic indexes, postoperative pain score, and incidences of nausea and vomiting were compared between the two groups.Results:Cough score in the observation group was significantly lower than that in the control group [(1.1 ± 0.4) points vs. (1.7 ± 0.7) points, t = -4.99, P < 0.05]. Ramsay Sedation Scale score in the observation group was significantly higher than that in the control group [(3.6 ± 1.0) points vs. (2.8 ± 0.8) points, t = 7.44, P < 0.05]. At 0 (T 1) and 5 minutes (T 2) after extubation, systolic blood pressure in the observation group was (117.7 ± 18.2) mmHg and (118.1 ± 16.2) mmHg, respectively, which were significantly lower than (134.2 ± 16.2) mmHg and (134.5 ± 15.2) mmHg in the control group ( t =-4.54, -4.95, both P < 0.05). There were no significant differences in the incidences of nausea and vomiting between the two groups (both P > 0.05). At 6 and 12 hours after surgery, visual analogue scale score in the observation group was (2.5 ± 0.8) points and (1.1 ± 0.5) points, respectively, which were significantly lower than (3.4 ± 0.9) points and (1.9 ± 0.8) points in the control group ( t = 5.01, -5.68, both P < 0.05). Conclusion:Oxycodone multimodal analgesia for laparoscopic gynaecological surgery can improve the quality of awakening, decrease systolic blood pressure, reduce the degree of postoperative pain, and does not increase the incidences of postoperative nausea and vomiting.
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Objective:To determine the dose-effect relationship of oxycodone inhibiting responses to endotracheal intubation with combination of etomidate-rocuronium during induction of general anesthesia.Methods:A total of 120 patients, aged 20-63 yr, with body mass index of 18.0-25.2 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective surgery under general anesthesia with tracheal intubation, were divided into 4 groups ( n=30 each) using a random number table method: group O 0.15, group O 0.23, group O 0.34 and group O 0.51.In O 0.15, O 0.23, O 0.34 and O 0.51 groups, oxycodone 0.15 mg/kg, 0.23 mg/kg, 0.34 mg/kg and 0.51 mg/kg were injected intravenously, respectively, 3 min later etomidate 0.3 mg/kg and rocuronium 0.8 mg/kg were intravenously injected in turn, and tracheal intubation was performed using Macintosh laryngoscope.Heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure immediately before intubation and the peak levels of HR, BP and diastolic blood pressure within 3 min after intubation were recorded.The response to endotracheal intubation was defined by the SBP and (or) HR having increased by more than 30% following intubation.The occurrence of adverse events during induction of anesthesia were recorded. Results:The rate of response to endotracheal intubation was 97%, 73%, 27%, and 3% in O 0.15, O 0.23, O 0.34 and O 0.51 groups, respectively.The median effective dose (ED 50) (95% confidence interval) of oxycodone inhibiting responses to endotracheal intubation was 0.259 (0.230-0.292) mg/kg, and the 95% effective dose (ED 95) (95% confidence interval) was 0.387 (0.358-0.420) mg/kg.Only the incidence of hypotension (27%) was significantly higher in group O 0.51 than in the other 3 groups ( P<0.05). Conclusion:With combination with etomidate-rocuronium, the ED 50 and ED 95 of oxycodone inhibiting responses to endotracheal intubation performed using Macintosh laryngoscope during induction of general anesthesia are 0.259 mg/kg and 0.387 mg/kg, respectively, and the optimum dose 0.51 mg/kg is recommended.
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Chronic pain is a common clinical manifestation in patients with advanced cancer, and pain treatment is a part of cancer treatment. The titration method of opiod drugs will be recommended for relieving pain in moderate-severe pain in order to improve the quality of life of patients with advanced cancer. Individualized pain control refers to the concept that different patients show different resistance responses to opiod drugs. This article briefly reviews the classification and mechanism of cancer pain, the titration method of opiod drugs in the cancer pain control and individualized application.
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【Objective】 To compare the efficacy and safety of oxycodone and sufentanil in transition analgesia after radical surgery of cervical cancer under general anesthesia. 【Methods】 A randomized, double-blind study was conducted. We randomly divided 68 patients on radical surgery of cervical cancer under general anesthesia into two groups: Group S (sufentanil in transition analgesia) (n=35) and Group O (oxycodone in transition analgesia) (n=33). Patients in Group S received sufentanil (0.1 μg/kg for endoscopy procedures or 0.15 μg/kg for laparotomy procedures), whereas patients in Group O received oxycodone (0.1 mg/kg for endoscopy procedures or 0.15 mg/kg for laparotomy procedures) 30 min before the end of operation as transition analgesia. We recorded the time of consciousness recovery and extubation, RSS restlessness score, the number of cough times, Ramsay score, Numerical Rating Scale (NRS) at rest in extubation immediately (T0), 30 min after extubation (T1), 1 h after extubation (T2), 2 h after extubation (T3), 4 h after extubation (T4), 12 h after surgery (T5), 24 h after surgery (T6), and the incidence of adverse complications within 24 h after operation. 【Results】 Compared with those in Group S, patients in Group O showed shorter time of consciousness recovery (4.28±3.35 vs. 5.53±2.25, P=0.027), shorter time of extubation (5.92±3.67 vs. 8.09±2.49, P=0.001), lower RSS restlessness score (0.38±0.49 vs. 0.83±0.63, P<0.001), smaller number of cough times (0.96±0.78 vs. 1.34±0.93, P=0.026), lower Ramsay score (2.3±0.58 vs. 2.63±0.85, P=0.017), and lower NRS score at rest in T3 and T4 (2.64±0.63 vs. 3.14±0.66; 2.86±0.81 vs. 3.69±0.75) (P<0.001). The incidence of nausea and vomiting was lower in Group O than in Group S (9.09% vs. 20%; 3.03% vs. 11.43%). 【Conclusion】 Both oxycodone and sufentanil provide adequate pain relief in transitional analgesia after radical surgery of cervical cancer under general anesthesia. However, oxycodone shows longer analgesia, faster recovery, and a lower incidence of side effects than sufentanil.
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Few pregnant women are prescribed oxycodone for cancer pain. Here, we report a case of neonatal abstinence syndrome in an infant born to a woman using oxycodone long term for cancer pain. During pregnancy, rather than the expected effects on pregnant women for oxycodone use, fetal growth was also favorable. However, the infant presented with respiratory failure after birth and required ventilator management. In addition, the infant required treatment for neonatal abstinence syndrome.
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Tumor lysis syndrome (TLS) is a metabolic disorder that is caused by acute lysis of massive tumor cells. We report a case with opioids-related severe respiratory depression induced by TLS. A 39-year-old man received chemotherapy for mycosis fungoides. Two hours after administration of chemotherapeutic agents, his renal function worsened, and he was diagnosed with TLS by laboratory and clinical findings. Moreover, he showed severe respiratory depression and pinpoint pupils, and become drowsy. These symptoms were attributed to oxycodone that had been administered to treat his tumor-related cutaneous pain, and were improved by injection of anti-opioids agent naloxone. In this case, we consider that the clearance of oxycodone was disrupted by renal dysfunction caused by TLS, leading to enhancement of the effects of oxycodone.
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To evaluate the value of oxycodone hydrochloride for postoperative pain management in patients undergoing patient-controlled intravenous analgesia(PCIA). The medical records on postoperative pain management in our department from January 1 to June 30,2018,were retrospectively analyzed.Totally 136 patients were assigned into oxycodone,sufentanil,or morphine groups according to the opioid used in the PCIA.Patients were assessed for postoperative pain severity(scored with NRS)and adverse reactions 24,36,and 48 hours after surgery.The area under curve(AUC)was calculated. The score of pain at exercise was significantly lower in the oxycodone group(2.2±2.4)than in the sufentanil group(3.4±2.1)(=0.305,=0.0126)or the morphine group(3.4±1.7)(=0.104,=0.0277)36 hours after surgery.AUC at rest was significantly lower in the oxycodone and morphine groups than in the sufentanil group(29.00,27.00,and 40.01,respectively);in contrast,AUC at exercise was significantly lower in the oxycodone group(63.17)than in the sufentanil and morphine groups(82.00 and 80.93,respectively).The consumption of opioids was significantly higher in the sufentanil group[(37.2±16.1),(46.1±24.3),(64.4±33.4)mg]than in the oxycodone group[(20.4±14.8)(=3.571,=0.001),(24.2±16.1)(=4.63,<0.0001),(34.4±25.1)mg(=6.409,<0.0001)]or the morphine group[(16.6±11.7)(=4.233,<0.0001),(20.5±14.1)(=5.250,<0.0001),(28.8±19.0)mg(=7.354,<0.0001)]24,36,48 hours after surgery.The oxycodone group experienced less vomiting(=11.360,=0.003)and early termination of PCIA(=7.914,=0.019)compared with the other two groups. Oxycodone can be used for postoperative PCIA.It can alleviate a variety of postoperative pain,with superior analgesic efficiency and safety to sufentanil and morphine.
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Objective To compare the perioperative application of sufentanil and oxycodone in patients undergoing laparoscopic surgery for gastric or colorectal cancer. Methods 59 patients were selected and randomly divided into group O and group S. Anesthesia was induced with sufentanil 0.3 μg/kg in group S and oxycodone 0.3 mg/kg in group O. Anesthesia was maintained with sevoflurane balanced anesthesia. When heart rate or blood pressure reached 20% over the baseline, additional dose of oxycodone 0.1 mg/kg was given in group O and sufentanil 0.1 μg/kg in group S. 30 minutes before the end of surgery, patients in group S received sufentanil 0.1 μg/kg and group O with oxycodone 0.1 mg/kg separately. Two hours in the PACU, a rescue dose of sufentanil 0.1 μg/kg or oxycodone 0.1 mg/kg was given to the patients with VAS score bigger than 4. Hemodynamic index, VAS score, Ramsay score, adverse responses and analgesics rescue were recorded. Results No difference was found in hemodynamic index, VAS score and analgesics rescue between the two groups (P>0.05). Ramsay score of group S is lower than that of group O (P=0.014). Induction period bucking incidence in group O was obviously lower than that in group S(P=0.002). The incidence of emergency agitation in group O was significantly lower than that in group S(P=0.045).There was no significant difference in respiratory depression, postoperative nausea and vomiting between two groups (P>0.05). Conclusion Compared with sufentanil, oxycodone significantly reduced the incidence of bucking and emergency agitation. Oxycodone provided better sedation to patients who received laparoscopic surgery for gastric or colorectal cancer.
الملخص
Objective To compare the analgesic effect and adverse reactions of oxycodone versus morphine after transcervical resection of adhesions (TCRA). Methods Sixty patients undergoing hysteroscopic TCRA under general anesthesia in Dalian Municipal Woman and Children′s Medical Center were randomly assigned to the test group or control group with 30 patients in each group; the test group received oxycodone 0.1 mg/kg (Q group), and the control group received morphine 0.1 mg/kg (M group). Both group was followed by propofol 2—3 mg/kg, as well as laryngeal mask airway (LMA) insertion after loss of consciousness to maintain ventilation. Propofol 6—10 mg/kg/h and remifentanil 0.1—0.2 μg/kg min were administered intraoperatively to maintain anesthesia. The visual analogue scale (VAS) score, sedation score and number of rescue medications were recorded immediately and 1 h, 2 h after the patient was sent to postoperative recovery room. The incidences of body movement, nausea and vomiting and pruritus after LMA insertion were recorded. Results There were no statistically significant differences between the two groups in VAS score, sedation score ,nausea and vomiting, itchy skin or the number of rescue medications at any post-recovery time point (P > 0.05); the incidence of body movements during LMA insertion was lower in M group: 13.3%(4/30) vs 36.7%(11/30), with statistically significant difference (P < 0.05). Conclusions Oxycodone could provide favorable postoperative analgesia for patients with intrauterine adhesion, with low incidence of adverse reactions.
الملخص
Objective To observe the clinical efficacy of Huajian-Badu membrane in the treatment of moderate and severe cancer pain. Methods The 80 malignant tumor patients with moderate to severe cancer pain from January 2016 to June 2017 in Tianjin University of Traditional Chinese Medicine First Teaching Hospital were recruited and randomly divided into the observation group and the control group, each of 40 cases. The control group were treated with Oxycodone Hydrochloride Prolonged-release Tablets, while the treatment group were treated with Huajian-Badu membrane on the basis of the treatment in control group. The pain relief, pain frequency, morphine consumption and quality of life (Karnofsky score), adverse reaction were evaluated between two groups before and after treatment. Results Compared with the control group, the total efficiency in the observation group was significantly higher (95.0％ vs. 80.0％, χ2=4.114, P=0.043). The frequency of breakthrough pain of two groups increased on the seventh and fourteenth treatment days(0.3 ± 0.6 times vs. 0.8 ± 0.7 times, t=-3.430 and 0.4 ± 0.6 times vs. 0.9 ± 0.8 times, t=-3.162), but the number of outbreaks of pain in the observation group significantly less than the control group (P<0.05 or P<0.01). The morphine injection dosage increased on the seventh and fourteenth treatment days (3.01 ± 4.28 g vs. 5.62 ± 6.37 g, t=-2.151 and 3.21 ± 4.32 g vs. 7.84 ± 7.76 g, t=-3.297), but the amount of the observtation group was significantly lower than that of control group (P<0.05 or P<0.01). The KPS score in the observation group increased significantly, and significantly higher than the control group on the seventh and fourteenth treatment days (73.0 ± 15.0 vs. 66.0 ± 12.0, t=2.305 and 77.0 ± 13.0 vs. 70.0 ± 15.0, t=2.230, P<0.05). The adverse reaction rate of the control group was 25％, while the the observation group was 20％. The difference between two groups was significant (χ2=0.287, P=0.592). Conclusions The Huajian-Badu membrane combined Oxycodone Hydrochloride Prolonged-release Tablets can improve the total effective rate of pain relief, reduce the number of outbreaks, reduce morphine consumption, improve patient KPS score of the patients with cancer pain.
الملخص
Objective To evaluate the effect of three different doses of oxycodone hydrochloride injection on uterine cramping pain and emotion in patients of artificial abortion.Methods Four hundred female patients, aged 17-38 years, BMI 18.5-23.9 kg/m2, falling into ASA physical statusⅠ orⅡ, undergoing elective artificial abortion were randomized into four groups using a random number table:group O1 (oxycodone 0.06 mg/kg), group O2 (oxycodone 0.08 mg/kg), group O3 (oxycodone 0.1 mg/kg), and group F, 100 cases in each.In group O1, group O2 and group O3, oxycodone 0.06, 0.08, 0.1 mg/kg were intravenously injected respectively, while in group F fentanyl1μg/kg was intravenously injected.Then, propofol 2.5 mg/kg was intravenously injected as induced dose.The operation was started when eyelash reflexes disappeared, propofol 0.4 mg/kg was intravenously injected when body movement appeared during the operation.The propofol doses, operation time and recovery time were recorded.HR, MAP, RR before anesthesia (T0), when loss of eyelash reflex (T1), operation (T2) and recovery (T3) were recorded.The uterine cramping pain was assessed with numerical rating scale (NRS) at recovery, 10, 30, 60 min after operation.Patients'satisfaction was recorded after operation.Patients'emotion was assessed with positive and negative affect scale (PANAS) both before and after operation in one hour.Rescue analgesia, nausea and vomiting, dizziness, respiratory depression, pruritus, uroschesis, cognitive dysfunction, sweatiness were recorded.Results The propofol doses and recovery time in groups O2, O3 and F were significantly lower than those in group O1 (P<0.05).The NRS score of uterine cramping pain in groups O1, O2 and O3 were significantly lower than that in group F (P<0.05).Patients'satisfaction in groups O1, O2 and O3 were significantly higher than that in group F (P<0.05).The positive affective score after operation in one hour among the four groups were significantly higher than that before operation (P<0.05), and the negative affective score after operation in one hour among the four groups were significantly lower than that before operation (P<0.05).The positive affective score after operation in one hour in groups O1, O2 and O3 were significantly higher than that in group F (P<0.05), and the rescue analgesia in groups O1, O2 and O3 were significantly lower than that in group F (P<0.05).There were no significant differences among the four groups as to the dizziness, nausea and vomiting.No respiratory depression, pruritus, emergence agitation, cognitive dysfunction, uroschesis and sweatiness were reported.Conclusion Oxycodone 0.08 mg/kg combined with propofol in patients undergoing artificial abortion is effective in preventing uterine cramping pain.Furthermore, the patients'satisfaction and positive affective score can also be improved.