Urolithiasis

, Volume 41, Issue 5, pp 423–430

Morphine versus oxycodone analgesia after percutaneous kidney stone surgery

A randomised double blinded study
  • Katja Venborg Pedersen
  • Anne Estrup Olesen
  • Asbjørn Mohr Drewes
  • Palle Jørn Sloth Osther
Original Paper

Abstract

According to previous studies oxycodone might have some advantages over morphine in the treatment of visceral pain. This study investigated the opioid consumption (primary outcome), pain relief and side effects (secondary outcomes) of morphine versus oxycodone after percutaneous nephrolithotomy using a method where the somatic pain component was minimized. Forty-four adult patients were studied. The patients were randomised to receive either morphine or oxycodone intravenously as postoperative pain treatment. During the first 4 h after surgery the opioid consumption, pain scores and side effects (nausea, dizziness, sedation, respiratory effects and itching) were registered. The postoperative opioid consumption varied considerably between the patients but the mean opioid consumption in the morphine and oxycodone group was comparable (18.93 mg versus 16.15 mg, P = 0.7). Nausea was significantly less frequent with morphine (P = 0.03). In this study morphine and oxycodone produced similar analgesia the first 4 h after surgery but the frequency of nausea was significantly less patient-reported with morphine. The hypothesis that oxycodone would be superior in the treatment of visceral pain after percutaneous kidney stone operation was not confirmed.

Keywords

Morphine Oxycodone Visceral pain Postoperative acute pain Kidney stone Percutaneous nephrolithotomy 

References

  1. 1.
    Cervero F, Laird JM (1999) Visceral pain. Lancet 353(9170):2145–2148CrossRefPubMedGoogle Scholar
  2. 2.
    Drewes AM, Jensen RD, Nielsen LM, Droney J, Christrup LL, Arendt-Nielsen L et al (2013) Differences between opioids: pharmacological, experimental, clinical and economical perspectives. Br J Clin Pharmacol 75(1):60–78CrossRefPubMedGoogle Scholar
  3. 3.
    Riley J, Eisenberg E, Müller-Schwefe G, Drewes AM, Arendt-Nielsen L (2008) Oxycodone: a review of its use in the management of pain. Curr Med Res Opin 24(1):175–192CrossRefPubMedGoogle Scholar
  4. 4.
    Ross FB, Smith MT (1997) The intrinsic antinociceptive effects of oxycodone appear to be kappa-opioid receptor mediated. Pain 73(2):151–157CrossRefPubMedGoogle Scholar
  5. 5.
    Nielsen CK, Ross FB, Lotfipour S, Saini KS, Edwards SR, Smith MT (2007) Oxycodone and morphine have distinctly different pharmacological profiles: radioligand binding and behavioural studies in two rat models of neuropathic pain. Pain 132(3):289–300CrossRefPubMedGoogle Scholar
  6. 6.
    Sengupta JN, Snider A, Su XGG (1999) Effects of kappa opioids in the inflamed rat colon. Pain 79:175–185CrossRefPubMedGoogle Scholar
  7. 7.
    Staahl C, Christrup LL, Andersen SD, Arendt-Nielsen L, Drewes AM (2006) A comparative study of oxycodone and morphine in a multi-modal, tissue-differentiated experimental pain model. Pain 123(1–2):28–36CrossRefPubMedGoogle Scholar
  8. 8.
    Staahl C, Dimcevski G, Andersen SD, Thorsgaard N, Christrup LL, Arendt-Nielsen L et al (2007) Differential effect of opioids in patients with chronic pancreatitis: an experimental pain study. Scand J Gastroenterol 42(3):383–390CrossRefPubMedGoogle Scholar
  9. 9.
    Staahl C, Upton R, Foster DJR, Christrup LL, Kristensen K, Hansen SH et al (2008) Pharmacokinetic-pharmacodynamic modeling of morphine and oxycodone concentrations and analgesic effect in a multimodal experimental pain model. J Clin Pharmacol 48(5):619–631CrossRefPubMedGoogle Scholar
  10. 10.
    Olesen AE, Upton R, Foster D, Staahl C, Christrup LL, Arent_nielsen LDA (2010) A pharmacokinetic and pharmacodynamic study of oral oxycodone in a human experimental pain model of hyperalgesia. Clin Pharmacokinet 49:817–827CrossRefPubMedGoogle Scholar
  11. 11.
    Olesen AE, Staahl C, Arendt-Nielsen L, Drewes AM (2010) Different effects of morphine and oxycodone in experimentally evoked hyperalgesia: a human translational study. Br J Clin Pharmacol 70(2):189–200CrossRefPubMedGoogle Scholar
  12. 12.
    Kalso R, Pöyhiä R, Onnela P, Linko K (1991) Tigerstedt I TT. Intravenous morphine and oxycodone for pain after abdominal surgery. Acta Anaesthesiol Scand 35:642–646CrossRefPubMedGoogle Scholar
  13. 13.
    Lenz H, Sandvik L, Qvigstad E, Bjerkelund CE, Raeder J (2009) A comparison of intravenous oxycodone and intravenous morphine in patient-controlled postoperative analgesia after laparoscopic hysterectomy. Anesth Analg 109(4):1279–1283CrossRefPubMedGoogle Scholar
  14. 14.
    Mercadante S, Tirelli W, David F, Arcara C, Fulfaro F, Casuccio A et al (2010) Morphine versus oxycodone in pancreatic cancer pain: a randomized controlled study. Clin J Pain 26(9):794–797CrossRefPubMedGoogle Scholar
  15. 15.
    Pedersen KV, Drewes AM, Frimodt-Møller PC, Osther PJS (2010) Visceral pain originating from the upper urinary tract. Urol Res 38(5):345–355CrossRefPubMedGoogle Scholar
  16. 16.
    Silvasti M, Rosenberg P, Seppälä T (1998) Svartling N PM. Comparison of analgesic efficacy of oxycodone and morphine in postoperative intravenous patient-controlled analgesia. Acta Anaesthesiol Scand 42(5):576–580CrossRefPubMedGoogle Scholar
  17. 17.
    Buhagiar L, Cassar OA, Brincat MP, Buttigieg GG, Inglott AS, Adami MZ et al (2011) Predictors of post-caesarean section pain and analgesic consumption. J Anaesthesiol Clin Pharmacol 27(2):185–191CrossRefPubMedGoogle Scholar
  18. 18.
    Werner MU, Mjöbo HN, Nielsen PR, Rudin A (2010) Prediction of postoperative pain: a systematic review of predictive experimental pain studies. Anesthesiology 112(6):1494–1502CrossRefPubMedGoogle Scholar
  19. 19.
    Neziri AY, Scaramozzino P, Andersen OK, Dickenson AH, Arendt-Nielsen L, Curatolo M (2011) Reference values of mechanical and thermal pain tests in a pain-free population. Eur J Pain 15(4):376–383CrossRefPubMedGoogle Scholar
  20. 20.
    Davis MP, Varga J, Dickerson D, Walsh D, LeGrand SB, Lagman R (2003) Normal-release and controlled-release oxycodone: pharmacokinetics, pharmacodynamics, and controversy. Support Care Cancer 11(2):84–92PubMedGoogle Scholar
  21. 21.
    Lloret Linares C, Declèves X, Oppert JM, Basdevant A, Clement K, Bardin C et al (2009) Pharmacology of morphine in obese patients: clinical implications. Clin Pharmacokinet 48(10):635–651CrossRefPubMedGoogle Scholar
  22. 22.
    Zwisler ST, Enggaard TP, Noehr-Jensen L, Mikkelsen S, Verstuyft C, Becquemont L et al (2010) The antinociceptive effect and adverse drug reactions of oxycodone in human experimental pain in relation to genetic variations in the OPRM1 and ABCB1 genes. Fundam Clin Pharmacol 24(4):517–524CrossRefPubMedGoogle Scholar
  23. 23.
    Kalso E, Vainio A (1990) Morphine and oxycodone hydrochloride in the management of cancer pain. Clin Pharmacol Ther 47:639–646CrossRefPubMedGoogle Scholar
  24. 24.
    Yanagidate F, Dohi S (2004) Epidural oxycodone or morphine following gynaecological surgery. Br J Anaesth 93(3):362–367CrossRefPubMedGoogle Scholar
  25. 25.
    Heiskanen T, Kalso E (1997) Controlled-release oxycodone and morphine in cancer related pain. Pain 73(1):37–45CrossRefPubMedGoogle Scholar
  26. 26.
    Backlund M, Lindgren L, Kajimoto Y, Rosenberg PH (1997) Comparison of epidural morphine and oxycodone for pain after abdominal surgery. J Clin Anesth 9(1):30–35CrossRefPubMedGoogle Scholar
  27. 27.
    Chang SH, Maney KM, Phillips JP, Langford RM, Mehta V (2010) A comparison of the respiratory effects of oxycodone versus morphine: a randomised, double-blind, placebo-controlled investigation. Anaesthesia 65(10):1007–1012CrossRefPubMedGoogle Scholar
  28. 28.
    Kantor TG, Hopper M, Laska E (1981) Adverse effects of commonly ordered oral narcotics. J Clin Pharmacol 21:1–8CrossRefPubMedGoogle Scholar
  29. 29.
    Wu C, Rowlingson A, Partin A, Kalish M, Courpas G, Walsh P et al (2005) Correlation of postoperative pain to quality of recovery in the immediate postoperative period. Reg Anesth Pain Med 30(6):516–522PubMedGoogle Scholar
  30. 30.
    Kehlet H, Wilmore DW (2008) Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg 248(2):189–198CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Katja Venborg Pedersen
    • 1
  • Anne Estrup Olesen
    • 2
  • Asbjørn Mohr Drewes
    • 2
  • Palle Jørn Sloth Osther
    • 1
  1. 1.Urological Research Centre, Department of Urology, Fredericia Hospital—part of Hospital LittlebeltUniversity of Southern DenmarkFredericiaDenmark
  2. 2.Mech-Sense, Department of Gastroenterology and HepatologyAalborg University HospitalAalborgDenmark

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