Efficacy and safety of controlled-release oxycodone and standard therapies for postoperative pain after knee or hip replacement.
BACKGROUND
Standard therapy (ST) for postoperative pain after knee and hip replacement at the Hamilton Health Sciences Henderson Hospital consists of epidural analgesia or patient-controlled analgesia for the first 48 hours, followed by oral or parenteral analgesics, or both, on an as-needed basis. We compared the efficacy and safety of scheduled controlled-release (CR) oxycodone hydrochloride (OxyContin; Purdue Pharma, Pickering, Ont.) and ST for postoperative pain 48 hours after primary knee and hip replacement.


METHODS
In 2 separate 3-week studies of similar design, pain intensity, pain relief, length of hospital stay, analgesic use and side effects of CR oxycodone (n = 70) and ST (n = 101) were evaluated. In the CR oxycodone trial, a dose de-escalation protocol was used.


RESULTS
At the time of discharge from hospital, patients in the CR oxycodone group recorded lower mean (and standard deviation) pain intensity scores than the ST group (20.2 [17.9] v. 27.7 [21.5] mm on a 100-mm visual analogue scale; p = 0.021). Length of hospital stay was 5.5 and 6.4 days for the CR oxycodone and ST groups respectively (p < 0.001). CR oxycodone patients used less opioid (morphine equivalent) while in hospital than ST patients (p < 0.001), and the average number of daily administrations of analgesics in hospital was 2.1 and 3.5 for CR oxycodone and ST patients respectively (p < 0.001). ST patients reported more nausea and vomiting, pruritus and fever than the CR oxycodone patients, but less somnolence, constipation, dizziness, confusion and tachycardia.


CONCLUSIONS
CR oxycodone every 12 hours is as effective as ST in treating postoperative pain but length of hospital stay was shorter and analgesic administration in the hospital was used less frequently, providing potential hospital cost savings and reduced use of health care resources.
de Beer
Justin de V
Jde V
Hamilton Arthroplasty Group, Hamilton Health Sciences Henderson Hospital, 711 Concession St., Hamilton, ON L8V 1C3. petrucce@hhsc.ca
Winemaker
Mitchell J
MJ
Donnelly
Graeme A E
GA
Miceli
Paula C
PC
Reiz
Joseph L
JL
Harsanyi
Zoltan
Z
Payne
Lance W
LW
Darke
Andrew C
AC
D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D019643:Arthroplasty, Replacement / Q000009:adverse effects*; D003692:Delayed-Action Preparations; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000601:surgery; D010098:Oxycodone / Q000627:therapeutic use*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D016896:Treatment Outcome
D000700:Analgesics; D000701:Analgesics, Opioid; D003692:Delayed-Action Preparations; D010098:Oxycodone