Controlled-release codeine is equivalent to acetaminophen plus codeine for post-cholecystectomy analgesia

  • Frances Chung
  • Doris Tong
  • Paula C. Miceli
  • Joseph Reiz
  • Zoltan Harsanyi
  • Andrew C. Darke
  • Lance W. Payne
General Anesthesia

Abstract

Purpose

Following ambulatory surgery, long-acting analgesics may provide advantages over short-acting analgesics. This study compared controlled-release codeine (CC) and acetaminophen plus codeine (A/C; 300 mg/30 mg) for pain control in the 48-hr period following laparoscopic cholecystectomy

Methods

Eligible patients were randomized to CC or A/C in a double-blind, double-dummy parallel group study. Unrelieved pain in hospital was treated with fentanyliv bolus. Rain [100 mm visual analogue scale (VAS)] was assessed before the first dose of medication; at 0.5, one, two, three, and four hours post-dose; at discharge; and three times a day for 48 hr. Adverse events were recorded and measures of patient satisfaction were assessed at the end of the study.

Results

Eighty-four patients were enrolled in the study; 42 patients in each group. There were no statistically significant differences between CC and A/C treatment. Mean VAS baseline pain was similar in both groups (P = 0.49) and there was no significant difference in the time to onset of analgesia (P = 0.17). At 0.5 hr, the mean VAS pain score was significantly reduced from baseline in both groups (P = 0.0001). The VAS pain scores at discharge were reduced 59% and 56% from baseline, respectively (P = 0.61). There was no difference between treatments in the incidence of adverse events and patients reported similar levels of satisfaction.

Conclusions

Controlled-release codeine provides an equivalent onset of analgesia, reduction in postoperative pain, and level of patient satisfaction, to acetaminophen plus codeine, over 48 hr following cholecystectomy, with the advantage of less frequent dosing.

La codéine à libération contrôlée est équivalente à de l’acétaminophène plus de la codéine pour l’analgésie postcholécystectomie

Résumé

Objectif

En chirurgie ambulatoire, les analgésiques postopératoires d’action prolongée peuvent avoir des avantages sur les analgésiques d’action brève. Nous comparons la codéine à libération contrôlée (CC) et une combinaison d’acétaminophène et de codéine (A/C; 300 mg/30 mg) comme analgésique pendant 48 h après une cholécystectomie laparoscopique.

Méthode

Des patients admissibles à l’expérimentation ont reçu de la CC ou de l’A/C lors d’une étude à double insu, à double placebo en contrôle parallèle. A l’hôpital, la douleur tenace a été traitée avec des bolus iv de fentanyl. La douleur [échelle visuelle analogique (EVA) de 100 mm] a été évaluée avant la première dose de médicament; à 0,5, une, deux, trois et quatre heures après la dose; au moment du départ et trois fois par pur pendant 48 h. Les événements indésirables ont été notés et des mesures de la satisfaction du patient ont été faites à la fin de l’étude.

Résultats

Létude a été réalisée auprès de 84 patients: 42 dans chaque groupe. Il n’y a pas eu de différence statistiquement significative entre les traitements à la CC ou à l’A/C. La douleur initiale moyenne a été similaire dans les deux groupes (P = 0,49) et il n’y a pas eu de différence significative de temps précédant le début de l’analgésie (P = 0,17). À 0,5 h, le score de douleur moyen à l’EVA était significativement réduit dans les deux groupes (P = 0,0001). Les scores à l’EVA au départ de l’hôpital ont été respectivement réduits de 59 % et de 56 % par rapport aux mesures initiales de la douleur (P = 0,61). Aucune différence intergroupe dans l’incidence d’événements indésirables n’a été notée et la satisfaction des patients était comparable d’un groupe à l’autre.

Conclusion

La codéine à libération contrôlée offre un délai d’installation de l’analgésie, une réduction de la douleur postopératoire et un niveau de satisfaction équivalents à une combinaison d’acétaminophène et de codéine pendant 48 h après une cholécystectomie, et ce, avec l’avantage d’un dosage moins fréquent.

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Copyright information

© Canadian Anesthesiologists 2004

Authors and Affiliations

  • Frances Chung
    • 1
  • Doris Tong
    • 1
  • Paula C. Miceli
    • 2
  • Joseph Reiz
    • 2
  • Zoltan Harsanyi
    • 2
  • Andrew C. Darke
    • 2
  • Lance W. Payne
    • 2
  1. 1.Department of AnesthesiaToronto Western HospitalTorontoCanada
  2. 2.Purdue PharmaPickeringCanada

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