title: Pain management after cesarean: a randomized controlled trial of oxycodone versus intravenous piritramide.
abstract: OBJECTIVE
  Primary objective was to assess whether oral analgesia with oxycodone offers superior pain relief after cesareans than patient controlled analgesia (PCA). Secondary outcomes were additional pain medication, time to first mobilization, therapeutic side effects, postoperative restrictions, overall satisfaction and costs.
  
  
  METHODS
  Randomized controlled trial at a University Hospital conduct between July 2009 and November 2009. Of the 1,112 patients, 257 met the inclusion criteria and 239 agreed to participate. Patients were randomly assigned to either receive intravenous piritramide PCA (2 mg piritramide/ml 0.9 % saline) or oral oxycodone (20 mg). Pain was assessed on a visual analog pain scale (VAS) at 2, 12, 24, 32, 40, 48 and 72 h after cesarean.
  
  
  RESULTS
  No differences in VAS scores were observed within the general study population. Pain scores of oxycodone versus PCA were comparable at 24 h. Patients randomized to PCA demonstrated increased demand for rescue medication 48 h after cesarean (p = 0.057). In the PCA group, patients with previous cesarean had increased operative times, a trend towards increased VAS scores after 48 h (p = 0.081) and increased VAS scores in comparison to patients who did not have cesarean before (p = 0.044). For this subgroup, no difference was seen in the oxycodone patients (p = 0.883).
  
  
  CONCLUSIONS
  General satisfaction with both treatment regimes was high. The results support the potential use of oral pain regimes and emphasis the importance of a multimodal approach to treat post-cesarean pain. Oral oxycodone is a not expensive, convenient and comparable analgesic to PCA devices with opioids after cesarean. Trial registration at clinicaltrials.gov identifier: NCT 01115101.
authors.affiliation: Department of Obstetrics and Gynecology, University of Rostock, Südring 81, 18059 Rostock, Germany. max.dieterich@uni-rostock.de
authors.forename: Max
authors.initials: M
authors.lastname: Dieterich
authors.forename: Katja
authors.initials: K
authors.lastname: Müller-Jordan
authors.forename: Johannes
authors.initials: J
authors.lastname: Stubert
authors.forename: Günther
authors.initials: G
authors.lastname: Kundt
authors.forename: Klaus
authors.initials: K
authors.lastname: Wagner
authors.forename: Bernd
authors.initials: B
authors.lastname: Gerber
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D002585:Cesarean Section / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D010098:Oxycodone / Q000008:administration & dosage*; D059408:Pain Management / Q000191:economics / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy*; D010892:Pirinitramide / Q000008:administration & dosage*; D011247:Pregnancy; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D010892:Pirinitramide; D010098:Oxycodone