COMPARISON OF EPIDURAL MORPHINE AND OXYCODONE FOR PAIN AFTER ABDOMINAL-SURGERY

Study Objective: To compare the efficacy and side effects of epidural morphine and oxycodone for pain following major abdominal surgery. Des ign: Randomized, double-blind study. Setting: 4th Department of Surger y, Helsinki University Central Hospital. Patients: 44 adult ASA physic al status I, II, and III patients scheduled for elective major abdomin al surgery. Interventions: Thirty-three patients were allocated random ly to one of two epidural groups and 11 patients received oxycodone in travenously (IV). The two epidural groups received either morphine (bo lus 0.015 mg/kg followed by an infusion 0.003 mg/kg/hr) or oxycodone ( bolus 0.15 mg/kg followed by an infusion 0.03 mg/kg/hr) before inducti on of standardized anesthesia and for 24 hours thereafter. A third gro up of patients was given the same dose of IV oxycodone as in the epidu ral group, serving as an open control group for epidural oxycodone. Me asurements and Main Results: Blood samples were drawn for plasma opioi d concentrations. Postoperatively, pain (at rest and during coughing), nausea, pruritus, sedation, respiratory rate, and hemodynamics were r ecorded until the end of the infusions. The epidural dose ratio betwee n morphine and oxycodone was 1:8.4 to 9.8 to provide similar analgesia . Side effects occurred similarly in the three groups. Mild respirator y depression was seen in all groups, especially in the IV oxycodone gr oup. In all groups, hemodynamic variables remained within normal limit s. Conclusions: In the dosages reported, oxycodone can be used epidura lly for acute postoperative pain. The analgesic effect was as good as that of epidural morphine. (C) 1997 Elsevier Science Inc.