A randomised comparison of regular oral oxycodone and intrathecal morphine for post-caesarean analgesia

• Published in: International journal of obstetric anesthesia Vol. 19; no. 1; pp. 16 - 23
• Main Authors: McDonnell, N.J, Paech, M.J, Browning, R.M, Nathan, E.A
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.01.2010
• Subjects: Administration, Oral; Adult; Anaesthesia; Analgesia, opioid; Analgesia, post-caesarean; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - therapeutic use; Anesthesia & Perioperative Care; Anesthesia, Spinal; Area Under Curve; Caesarean section; Cesarean Section; Double-Blind Method; Female; Humans; Injections, Spinal; Morphine - administration & dosage; Morphine - therapeutic use; Obstetrical; Obstetrics and Gynecology; Oxycodone - administration & dosage; Oxycodone - therapeutic use; Pain Measurement; Pain, postoperative; Pain, Postoperative - drug therapy; Postoperative Nausea and Vomiting - epidemiology; Pregnancy; Young Adult; Anaesthesia; Analgesia, opioid; Obstetrical; Caesarean section; Pain, postoperative; Analgesia, post-caesarean
• ISSN: 0959-289X; 1532-3374
• DOI: 10.1016/j.ijoa.2009.03.004

Abstract Background Primary post-caesarean analgesia based on oral opioid has not been adequately studied. This approach may show a good side-effect profile and high satisfaction and avoid neuraxial complications. Methods In a double-blind, double-dummy, placebo-controlled clinical trial 120 women were randomised to receive either sustained-release oral oxycodone 20 mg in the recovery room followed by immediate-release oxycodone 10 mg 6-hourly for the first 24 h (group O) or intrathecal morphine 100 μg at the time of spinal anaesthesia (group I). All women received regular postoperative diclofenac, paracetamol and standardised supplemental analgesia. Results One hundred and eleven women completed the study. The area under the curve for pain scores to 24 h did not differ significantly between groups for pain at rest ( P =0.465) or on movement ( P =0.533). Numerical pain scores were low and similar, except at rest at 12 h (group I 1 [0-2] vs. group O 2 [1-3]; P =0.030). The time to first analgesic request was similar but additional postoperative analgesics were required more often in group O (82% vs. 63%, P= 0.034). Group O more frequently reported high worst pain scores (score 4-10 in 87% vs. 64%, P= 0.007). Pruritus was more common and more severe in group I (87% vs. 56%, P= 0.001). At 24 h maternal satisfaction with the analgesic regimen was lower in group O ( P= 0.010). Conclusion Oral oxycodone produced comparable postoperative pain relief to intrathecal morphine with a lower incidence of pruritus, but was associated with a lower satisfaction score.