Kumar, Shyamala a/p V.
(2016)
Comparison on the efficacy of immediate release oxycodone and tramadol in reducing postoperative pain, nausea and vomiting in post laparotomy patients weaned from PCA morphine.
Masters thesis, Universiti Sains Malaysia.
Abstract
Introduction : The introduction of oxycodone into the Malaysian health care system in
recent years has opened up another option for postoperative pain relief. We assess the
clinical efficacy of oral oxycodone IR in reducing pain as well as nausea and vomiting
and compare it to oral tramadol in this postoperative study.
Objective: This was a prospective, randomised, double blinded study on the efficacy of
oxycodone IR as oral maintenance analgesia in reducing postoperative pain, analgesic
requirement and incidence of nausea and vomiting in patients post laparotomy after
PCA morphine is weaned off. This study was conducted in Hospital Universiti Sains
Malaysia.
Methodology : We recruited 40 patients undergoing an elective laparotomy for
gynaecological surgery. These patients were randomly selected to receive oral
oxycodone IR once PCA morphine was weaned off 48 hours post surgery. The other
group of patients received the standard oral tramadol. Postoperative pain scores were
assessed using the Combination Rating Scale and requirement of rescue analgesia at 2
hours, 6 hours, 24 hours and on day 3 of oral analgesia. Incidence of nausea was
documented along with the requirement of rescue antiemetics at the same intervals.
Assessment was made by pain services nurses and data was entered using Statistical
Package for Social Science SPSS Version 22.
Results: This study revealed that patients receiving oral oxycodone IR had significantly
lower pain scores of less than 4 which was achieved within 6 hours of treatment. This
level was only achieved by the tramadol group at 24 hours of treatment. This is
significant with a p value < 0.001 based on time and treatment effects. Requirement of
1st and 2nd line rescue analgesia was significant between groups. 10% of the oxycodone
group and 60% of the tramadol group needed 1st line rescue and 5% of the oxycodone
group against 40% of the tramadol required rescue analgesia. Incidence of nausea was
significantly lower in the oxycodone group only at 2 hours with a p value of 0.022. The
requirement of 1st and 2nd line rescue antiemetics was lower in the oxycodone group
however remained insignificant with a p value of > 0.05. Finally the mean satisfaction
score for patients on oxycodone was 6.85 compared to 5.75 over a score of 10 with a
significant mean difference of p value < 0.001.
Conclusion : The introduction of oral oxycodone IR in the postoperative period for post
laparotomy patients who were weaned from PCA morphine showed better pain scores
and less analgesic requirement. These patients also had reduced incidence of nausea at 2
hours and better overall patient satisfaction scores compared to the tramadol group.
However, there was no significant difference in the antiemetic requirement between the
two groups
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