Postoperative analgesia with controlled-release oxycodone for outpatient anterior cruciate ligament surgery

Reconstruction of the anterior cruciate ligament (ACL) of the knee is assoc iated with a considerable degree of postoperative pain. Although immediate- release oral opioids are usually effective in relieving moderate to severe pain, they must be given every 4-6 h. A controlled-release (CR) formulation of oxycodone maintains therapeutic opioid concentrations for a more prolon ged period, thus providing sustained pain relief. We designed this study to determine whether CR oxycodone is more effective and clinically acceptable than immediate-release oxycodone for managing pain after ambulatory ACL re pair surgery. All patients received a standard general anesthetic and posto perative analgesic regimen with one of three oxycodone dosing regimens: oxy codone 10 mg every 4 h as needed, oxycodone 10 mg every 4 h, and CR oxycodo ne 20 mg every 12 h. Rescue analgesic consisted of oxycodone 5 mg every 6 h as needed. At 24, 36, 48, 60, and 72 h, there was a difference in pain sco res among the groups (P < 0.0001); there was less pain in the CR oxycodone group. At most times, the fixed-dose group had lower pain scores than the a s-needed group. The sedation scores were significantly different at 12 h (P < 0.02) and at 24, 36, 48, 60, and 72 h (P < 0.0001); the patients were mo re alert in the CR oxycodone group. The 72-h consumption of oxycodone was l ess in the CR oxycodone group (P < 0.0001). The patients had less sleep dis turbance (P < 0.0001), were more satisfied (P < 0.0001), and experienced le ss vomiting (P < 0.02) in the CR oxycodone group compared with the other tw o groups. In conclusion, using CR oxycodone in the immediate 72 h after amb ulatory ACL surgery provides more effective analgesia with less sedation, s leep disturbance, and postoperative vomiting compared with oxycodone prescr ibed on either a fixed dose or as-needed schedule. Implications: A controll ed-release formulation of oxycodone in patients undergoing anterior cruciat e ligament repair on an ambulatory basis provides significant analgesic ben efit and a lowering of side effects compared with either fixed-dose or as-n eeded oxycodone regimens.