Preoperative administration of controlled-release oxycodone as a transition opioid for total intravenous anaesthesia in pain control after laparoscopic cholecystectomy.
BACKGROUND
The complexity of pain from laparoscopic cholecystectomy and the need for treating incident pain provide rationale for multipharmacological analgesia. We investigated the preoperative administration of controlled-release (CR) oxycodone as transition opioid from remifentanil infusion for pain after laparoscopic cholecystectomy.


METHODS
Fifty consecutive patients undergoing laparoscopic cholecystectomy were randomly, double-blindly assigned to treatment group (n=25, CR oxycodone: 1 h before surgery and 12 h after the first administration) or to the control group (n=25, placebo: administered at the same intervals). General anaesthesia was maintained with propofol and remifentanil target-controlled infusions (TCIs). All patients received ketorolac 30 mg i.v. Tramadol i.v. was administered for patient-controlled analgesia (PCA) postoperatively. Numerical rating scale for pain at rest and at movement (NRSr and NRSi), tramadol consumption, times to readiness to surgery and awakening, times to modified Aldrete's and modified Post-Anesthetic Discharge Scoring System (PADSS)>9 and side effects were evaluated.


RESULTS
All NRSr and NRSi and tramadol consumption were significantly lower in the treatment group. The oxycodone group showed higher modified Aldrete's scores at each time and reached a PADSS>9 faster. Side effects and postoperative nausea and vomiting episodes were comparable.


CONCLUSIONS
We demonstrated the success of a multipharmacological treatment including opioid premedication with CR oxycodone used as transition opioid for TCI remifentanil infusion; the treatment group showed lower pain scores and rescue analgesic consumption, shorter time to discharge from recovery room and from surgical ward, and the same incidence of side effects, comparably to controls.
Fanelli
Guido
G
Department of Anaesthesia, Intensive Care and Pain Therapy, University Hospital of Parma, viale Gramsci 14, 43100 Parma, PR, Italy. guido.fanelli@unipr.it
Ghisi
Daniela
D
Berti
Marco
M
Troglio
Raffaella
R
Ortu
Andrea
A
Consigli
Camilla
C
Casati
Andrea
A
D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000771:Anesthesia, Intravenous; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D003692:Delayed-Action Preparations / Q000008:administration & dosage; D004311:Double-Blind Method; D006801:Humans; D008875:Middle Aged; D010098:Oxycodone / Q000008:administration & dosage*; D010149:Postoperative Pain / Q000209:etiology* / Q000517:prevention & control*; D011300:Preoperative Care; D011446:Prospective Studies
D000701:Analgesics, Opioid; D003692:Delayed-Action Preparations; D010098:Oxycodone