Controlled-Release Oxycodone as “Gold Standard” for Postoperative Pain Therapy in Patients Undergoing Video-Assisted Thoracic Surgery or Thoracoscopy: A Retrospective Evaluation of 788 Cases
11 August 2014
27 October 2014
20 January 2015 (online)
Background To assess the clinical efficacy of controlled-release oxycodone for postoperative analgesia after video-assisted thoracic surgery (VATS) or thoracoscopy.
Methods Pain therapy is standardized in our thoracic center throughout the complete postoperative stay. Patients receive immediately postoperative standardized oral analgesic protocol with controlled-released oxycodone (Oxy Group) or oxycodone with naloxone (Targin Group) and nonopioid every 6 h. We switched the opioid protocol from controlled-release oxycodone to Targin in January 2012. All patients are visited daily by a pain specialist throughout the whole stay.
Results Data of 788 patients undergoing VATS (n = 367) or thoracoscopy (n = 421) during January 2011 until March 2013 were analyzed. In VATS, patients with Targin had higher pain scores at rest (p < 0.02) and on coughing (p < 0.001) than patients with oxycodone alone and more patients with Targin were dismissed with oral opioid dose than patients with oxycodone alone (p < 0.001). No differences in pain scores on POD 5 and 6, or in length of hospital stay, incidence of nausea, time to first dejection or opioid dose after dismission were found between controlled-release oxycodone and Targin. After conventional thoracoscopy, 209 patients received controlled-release oxycodone and 212 Targin. Patients with Targin had higher pain scores at rest (p < 0.004) and on coughing (p < 0.01) than patients with oxycodone alone and more patients with Targin were dismissed with oral opioid dose than patients with oxycodone alone (p < 0.004). There were no differences in pain scores on POD 5 and 6, or in length of hospital stay, incidence of nausea, time to first dejection or opioid dose after dismission.
Conclusion Oral opioid analgesia with controlled-release oxycodone is an effective postoperative regimen after VATS and thoracoscopies. Our retrospective data indicate that Targin might be less effective analgesic than oxycodone after VATS and thoracoscopies with no improvement in bowel function in the immediate postoperative period.
Study Limitations The study design is retrospective in nature.
- 1 Gottschalk A, Cohen SP, Yang S, Ochroch EA. Preventing and treating pain after thoracic surgery. Anesthesiology 2006; 104 (3) 594-600
- 2 Fibla JJ, Molins L, Mier JM, Sierra A, Carranza D, Vidal G. The efficacy of paravertebral block using a catheter technique for postoperative analgesia in thoracoscopic surgery: a randomized trial. Eur J Cardiothorac Surg 2011; 40 (4) 907-911
- 3 Joshi GP, Bonnet F, Shah R , et al. A systematic review of randomized trials evaluating regional techniques for postthoracotomy analgesia. Anesth Analg 2008; 107 (3) 1026-1040
- 4 Kampe S, Lüttecke D, Wolter K, Cheufou DH, Stamatis G. Minimal incidence of chronic and neuropathic postthoracotomy pain after anteroaxillary thoracotomy with consequent systemic pain therapy. Eur J Anaesthesiol 2014; 31 (9) 508-511
- 5 Kampe S, Lohmer J, Weinreich G, Hahn M, Stamatis G, Welter S. Epidural analgesia is not superior to systemic postoperative analgesia with regard to preventing chronic or neuropathic pain after thoracotomy. J Cardiothorac Surg 2013; 8: 127-11
- 6 Pogatzki-Zahn EM, Englbrecht JS, Pöpping D, Boche R, Zahn PK. Oral therapy algorithm for the treatment of postoperative pain. A prospective observational study [in German]. Schmerz 2013; 27 (1) 26-37
- 7 Simpson K, Leyendecker P, Hopp M , et al. Fixed-ratio combination oxycodone/naloxone compared with oxycodone alone for the relief of opioid-induced constipation in moderate-to-severe noncancer pain. Curr Med Res Opin 2008; 24 (12) 3503-3512
- 8 Meissner W, Leyendecker P, Mueller-Lissner S , et al. A randomised controlled trial with prolonged-release oral oxycodone and naloxone to prevent and reverse opioid-induced constipation. Eur J Pain 2009; 13 (1) 56-64