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Analgesic efficacy and safety of epidural oxycodone in patients undergoing total hip arthroplasty: a pilot study

Authors Olczak B, Kowalski G, Leppert W, Bienert A, Teżyk A, Adamski M, Rzymski S, Wieczorowska-Tobis K

Received 24 June 2017

Accepted for publication 28 August 2017

Published 27 September 2017 Volume 2017:10 Pages 2303—2309

DOI https://doi.org/10.2147/JPR.S144799

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 3

Editor who approved publication: Dr Michael Schatman

Bogumił Olczak,1 Grzegorz Kowalski,1,2 Wojciech Leppert,2 Agnieszka Bienert,3 Artur Teżyk,4 Michał Adamski,1 Stanisław Rzymski,1 Katarzyna Wieczorowska-Tobis2

1Department of Anaesthesiology, Józef Struś Multiprofile Municipal Hospital, Poznań, 2Department of Palliative Medicine, 3Department of Clinical Pharmacy and Biopharmacy, 4Department of Forensic Medicine, Poznan University of Medical Sciences, Poznań, Poland

Background and objectives: Oxycodone is poorly studied as an adjuvant to central blockades. The aim of this pilot study was to assess the efficacy and safety of oxycodone hydrochloride in epidural blockade among patients undergoing total hip arthroplasty (THA).
Patients and methods: In 11 patients (American Society of Anesthesiologists physical status classification system II/III, age range: 59–82 years), THA was conducted with an epidural blockade using 15 mL 0.25% bupivacaine (37.5 mg) with 5 mg oxycodone hydrochloride and sedation with propofol infusion at a dose of 3–5 mg/kg/h. After the surgery, patients received ketoprofen at a dose of 100 mg twice daily. In the first 24 hours postoperative period, pain was assessed by numerical rating scale at rest and on movement; adverse effects (AEs) were recorded; and plasma concentrations of oxycodone, noroxycodone, and bupivacaine were measured.
Results: The administration of epidural oxycodone at a dose of 5 mg in patients undergoing THA provided analgesia for a mean time of 10.3±4.89 h. In one patient, mild pruritus was observed. Oxycodone did not evoke other AEs. Plasma concentrations of oxycodone while preserving analgesia were >2.9 ng/mL. Noroxycodone concentrations in plasma did not guarantee analgesic effect.
Conclusion: The administration of epidural oxycodone at a dose of 5 mg prolongs the analgesia period to ~10 hours in patients after THA. Oxycodone may evoke pruritus. A 5 mg dose of oxycodone hydrochloride used in an epidural blockade seems to be a safe drug in patients after THA.

Keywords: analgesia, oxycodone, pain, total hip arthroplasty
 

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