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

作者：McDonnell N J^*; Paech M J; Browning R M; Nathan E A

来源：International Journal of Obstetric Anesthesia, 2010, 19(1): 16-23.

DOI：10.1016/j.ijoa.2009.03.004

• Caesarean section
• Anaesthesia
• Obstetrical
• Pain, postoperative
• Analgesia, opioid
• Analgesia, post-caesarean

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 0) or intrathecal morphine 100 mu g at the time of spinal anaesthesia (group 1). 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 0 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 1 (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.

• 出版日期2010-1