Comparison of epidural morphine and oxycodone for pain after abdominal surgery.
OBJECTIVE
To compare the efficacy and side effects of epidural morphine and oxycodone for pain following major abdominal surgery.


METHODS
Randomized, double-blind study.


METHODS
4th Department of Surgery, Helsinki University Central Hospital.


METHODS
44 adult ASA physical status I, II, and III patients scheduled for elective major abdominal surgery.


METHODS
Thirty-three patients were allocated randomly to one of two epidural groups and 11 patients received oxycodone intravenously (IV). The two epidural groups received either morphine (bolus 0.015 mg/kg followed by an infusion 0.003 mg/kg/hr) or oxycodone (bolus 0.15 mg/kg followed by an infusion 0.03 mg/kg/hr) before induction of standardized anesthesia and for 24 hours thereafter. A third group of patients was given the same dose of IV oxycodone as in the epidural group, serving as an open control group for epidural oxycodone.


RESULTS
Blood samples were drawn for plasma opioid concentrations. Postoperatively, pain (at rest and during coughing), nausea, pruritus, sedation, respiratory rate, and hemodynamics were recorded until the end of the infusions. The epidural dose ratio between morphine and oxycodone was 1:8.4 to 9.8 to provide similar analgesia. Side effects occurred similarly in the three groups. Mild respiratory depression was seen in all groups, especially in the IV oxycodone group. In all groups, hemodynamic variables remained within normal limits.


CONCLUSIONS
In the dosages reported, oxycodone can be used epidurally for acute post-operative pain. The analgesic effect was as good as that of epidural morphine.
Backlund
M
M
Department of Anaesthesia, Helsinki University Central Hospital, Finland.
Lindgren
L
L
Kajimoto
Y
Y
Rosenberg
P H
PH
D000005:Abdomen / Q000601:surgery*; D015360:Analgesia, Epidural; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D020910:Ketorolac; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010098:Oxycodone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D014046:Tolmetin / Q000031:analogs & derivatives / Q000627:therapeutic use
D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D009020:Morphine; D010098:Oxycodone; D014046:Tolmetin; D020910:Ketorolac