Abstract
Purpose
Oral analgesia after “fast-track” cardiac anesthesia has not been explored. The aim of this study was to compare two oral oxycodone analgesic regimens.
Methods
One hundred-twenty patients scheduled for coronary artery bypass grafting were randomly assigned postoperatively to receive immediate-release oxycodone 5 mg and acetaminophen 325 mg (Percocet-5) (group I)per os four times daily, or controlled-release oxycodone 10 mg (OxyContin) (group II)per os every 12 hr and placebo twice daily. Acetaminophen 500 mgper os was used as first-line rescue medication, and immediate-release oxycodone (syrup form) 5 mgper os as second-line rescue medication. Pain intensity was assessed with a visual analogue scale on the first postoperative day, the morning after extubation, and thereafter four times daily for four days. Use of rescue medication and adverse events were recorded.
Results
Baseline demographic and operation-related characteristics were similar in both groups. While pain control was good in both groups, the immediate-release group experienced less pain on all postoperative days (P = 0.003), required significantly less rescue medication, and had fewer adverse effects such as somnolence and nausea.
Conclusion
Peroral oxycodone is effective for early pain control after fast-track cardiac anesthesia. Immediate-release oxycodone/acetaminophen appears to provide better analgesia and fewer side effects compared to controlled-release oxycodone.
Résumé
Objectif
L’analgésie orale après la technique accélérée d’anesthésie cardiaque n’a pas été étudiée. Le but de cette étude était de comparer deux régimes d’analgésie à l’oxycodone per os.
Méthodes
Cent- vingt patients devant subir une chirurgie de revascularisation myocardique ont été aléatoirement répartis en deux groupes après l’opération : le groupe I a reçu 5 mg d’oxycodone à libération immédiate et 325 mg d’acétaminophène (Percocet- 5) per os quatre fois par jour, et le groupe II a reçu 10 mg d’oxycodone à libération contrôlée (OxyContin) per os chaque 12 h et un placebo deux fois par jour. L’acétaminophène (500 mg per os) a été utilisé comme médicament de sauvetage de première intention et l’oxycodone (5 mg per os à libération immédiate sous forme de sirop) comme médicament de sauvetage de seconde intention. L’intensité de la douleur a été évaluée à l’aide d’une échelle visuelle analogue le premier jour après l’opération, le matin suivant l’extubation, puis quatre fois par jour pendant quatre jours. L’utilisation de médicaments de sauvetage ainsi que les complications ont été enregistrées.
Résultats
Les caractéristiques démographiques de base ainsi que celles en rapport avec l’opération furent similaires dans les deux groupes. Bien que le contrôle de la douleur ait été bon dans les deux groupes, les patients du groupe à libération immédiate ont ressenti moins de douleur durant les jours suivant l’opération (P = 0,003), ont eu besoin d’une dose significativement moindre de médicaments de sauvetage, et ont subi moins d’événements négatifs tels que la somnolence ou la nausée.
Conclusion
L’oxycodone peroral est efficace pour un contrôle de la douleur précoce après une technique accélérée d’anesthésie cardiaque. L’oxycodone / acétaminophène à libération immédiate semble fournir une meilleure analgésie et moins d’effets secondaires que l’oxycodone à libération contrôlée.
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Kogan, A., Medalion, B., Raanani, E. et al. Early oral analgesia after fast-track cardiac anesthesia. Can J Anesth 54, 254–261 (2007). https://doi.org/10.1007/BF03022769
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DOI: https://doi.org/10.1007/BF03022769