title: Oral oxycodone offers equivalent analgesia to intravenous patient-controlled analgesia after total hip replacement: a randomized, single-centre, non-blinded, non-inferiority study.
abstract: BACKGROUND
  To determine if oral oxycodone (OOXY) could provide equivalent postoperative analgesia and a similar side-effect profile to i.v. patient-controlled morphine in patients undergoing elective primary total hip replacement (THR) under spinal anaesthesia.
  
  
  METHODS
  We studied 110 consecutive patients aged 60-85 yr. After operation, patients were randomly allocated to receive either oral controlled- and immediate-release OOXY or i.v. patient-controlled analgesia (IVPCA) with morphine. Both groups received regular co-analgesia and antiemetics. The primary outcome measures were: (i) postoperative pain at rest and movement and (ii) nausea score recorded 12 hourly. The secondary outcome measures were: (i) time to first mobilization, (ii) total amount of opioid consumed, (iii) number of additional antiemetic doses, and (iv) time to analgesic discontinuation.
  
  
  RESULTS
  There were no statistically significant differences in the primary outcome measures of pain at rest and movement (P>0.05, 95% confidence intervals -0.41, +0.96) or nausea score (P>0.5). The secondary outcome measures showed no significant difference in the total amount of opioid consumed (102 vs 63 mg; P>0.05) or time to mobilization (24.45 vs 26.6 h, P=0.2). The number of antiemetic doses required in the first 24 h was significantly lower in the OOXY group (1.1 vs 1.4, P<0.05). The time to analgesic discontinuation was significantly shorter in the OOXY group (50.5 vs 56.6 h, P<0.05). Oral analgesia with OOXY was approximately GBP 10 less expensive per patient than IVPCA.
  
  
  CONCLUSIONS
  Oral analgesia with OOXY after THR offers non-inferior analgesia to IVPCA and may offer some logistical and cost advantages.
authors.affiliation: Department of Anaesthetics, Victoria Road, Macclesfield, Cheshire SK10 3BL, UK.
authors.forename: M P
authors.initials: MP
authors.lastname: Rothwell
authors.forename: D
authors.initials: D
authors.lastname: Pearson
authors.forename: J D
authors.initials: JD
authors.lastname: Hunter
authors.forename: P A
authors.initials: PA
authors.lastname: Mitchell
authors.forename: T
authors.initials: T
authors.lastname: Graham-Woollard
authors.forename: L
authors.initials: L
authors.lastname: Goodwin
authors.forename: G
authors.initials: G
authors.lastname: Dunn
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D000775:Anesthesia, Spinal; D000932:Antiemetics / Q000008:administration & dosage; D019644:Arthroplasty, Replacement, Hip; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects; D010098:Oxycodone / Q000008:administration & dosage* / Q000009:adverse effects; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000517:prevention & control*; D011182:Postoperative Care / Q000379:methods; D020250:Postoperative Nausea and Vomiting / Q000139:chemically induced / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D000932:Antiemetics; D009020:Morphine; D010098:Oxycodone