Pain relief after total hip replacement: oral CR oxycodone plus IV paracetamol versus epidural levobupivacaine and sufentanil. A randomized controlled trial.
BACKGROUND
We tested the hypothesis that pain relief after total hip replacement (THR) can be obtained with a multimodal approach using oral controlled release (CR) oxycodone plus IV paracetamol.


METHODS
Two hundred and sixty patients undergoing THR were randomized into two groups. A group of 130 patients (EPI) under epidural anesthesia followed by continuous infusion of levobupivacaine 0.125% and sufentanil 0.7 mcg/mL at 7 mL/h was compared with a group (OXY) of 130 patients under spinal anesthesia and oral CR oxycodone 10 mg/q12h plus IV paracetamol 1g/q6h. Pain intensity at rest and dynamic by visual analogue scores (VAS), rescue dose consumption and side effects of three postoperative days (POD) were collected and analyzed with Mann-Withney test (P<0.05 was considered significant).


RESULTS
VAS values at rest were similar in both groups at POD#1, significantly lower in the OXY group either at POD#2 (P=0.018) and POD#3 (P=0.001). Dynamic VAS values were significantly lower in the EPI group at POD#1 (P=0.001), similar for both groups at POD#2 and significantly lower in the OXY group at POD#3 (P=0.026) than the comparing group. Rescue dose consumption was significantly lower in the EPI group during the POD#1 (P=0.009), similar for both groups at POD#2 and higher in the EPI at POD#3 (P=0.008). The incidence of vomiting was similar for the two groups. Nausea was more frequent in the OXY group at POD#3 and more hypotension events occurred in the OXY group at POD#2.


CONCLUSIONS
Oral CR oxycodone plus IV paracetamol was as effective as epidural levobupivacaine and sufentanil for postoperative pain relief after THR.
Department of Anesthesia and Intensive Care Medicine, S. Maria della Misericordia University Hospital, University of Udine, Udine, Italy. divella.michele@aoud.sanita.fvg.it
M
M
Divella
M
M
Cecconi
N
N
Fasano
N
N
Langiano
M
M
Buttazzoni
I
I
Gimigliano
G
G
Della Rocca
D000082:Acetaminophen / Q000008:administration & dosage*; D000284:Administration, Oral; D000368:Aged; D015360:Analgesia, Epidural; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage*; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D019644:Arthroplasty, Replacement, Hip; D002045:Bupivacaine / Q000008:administration & dosage / Q000031:analogs & derivatives; D003692:Delayed-Action Preparations; D004359:Drug Therapy, Combination; D006801:Humans; D007262:Infusions, Intravenous; D000077554:Levobupivacaine; D008875:Middle Aged; D010098:Oxycodone / Q000008:administration & dosage*; D010149:Postoperative Pain / Q000188:drug therapy*; D017409:Sufentanil / Q000008:administration & dosage*
D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D003692:Delayed-Action Preparations; D000082:Acetaminophen; D000077554:Levobupivacaine; D017409:Sufentanil; D010098:Oxycodone; D002045:Bupivacaine