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October 12, 2014
8:00 AM - 10:00 AM
Room Hall B1-Area C
Intravenous Bolus of Oxynorm Reduces Postoperative Additional Analgesic Requirements in Patients Undergoing Laparoscopic Cholecystectomy
Yoonji Choi, M.D., Ph.D., Sang Wook Park, M.D., Young Jin Moon, M.D., Yu Mi Lee, M.D., Ph.D.
Inje University Seoul Paik Hospital, Seoul, Korea, Republic of
Background: Oxycodone (Oxynorm®, Mundipharma, Vantaa, Finland) is an opioid analgesic effective for the relief of moderate to severe (visual analog scale [VAS] score of above 5) postoperative and cancer pain. For laparoscopic cholecystectomy, pain is most frequent complaint and the most common cause of delayed discharge. Visceral and shoulder pain account for most of the pain experienced after laparoscopic cholecystectomy, whereas patients complain more of the parietal pain after laparotomy. Therefore, the effectiveness and clinical value of intravenous oxynorm for treating pain in patients undergoing laparoscopic cholecystectomy were evaluated in this study.

Methods: We enrolled 87 patients ASA class I and II, scheduled for elective laparoscopic cholecystectomy. The patients were randomized to receive placebo, oxynorm 0.1 mg/kg or lidocaine 1.5 mg/kg1 followed by a continuous infusion of lidocaine 2 mg/kg/hr after the incision of surgery. Postoperative shoulder and abdominal pain intensity were recorded on a numeric grading scale and a VAS at 1, 2, 4, 12, 24 hours after surgery, respectively. We defined the pain as VAS score of above 5. Additional analgesic (fentanyl) consumption was also recorded. Side effects and recovery variables were assessed by the nurses in the recovery room.

Results: Oxynorm or lidocaine reduced incidence of pain (P<0.01), pain scores (P<0.05). In PACU, fentanyl consumption (P<0.01) at 0.5, 1, 6, and 24 hours after surgery also decreased compared to control group. There was no difference between oxynorm and lidocaine group in pain scores and the incidence of pain. Intraoperative blood pressure and heart rate were not significantly differences between groups. There were no significant differences in recovery variables, time to first additional analgesic need, or incidence of side effects between the two groups.

Conclusion: Intravenous oxynorm bolus is simple to use and results in a long-lasting reduction of shoulder and abdominal postoperative pain for 24 h after laparoscopic cholecystectomy and opioid consumption in the PACU.

Fig. 1. Mean arterial pressure changes. Blood A: drug injection, B: end of surgery, C: 5 min after the end of surgery, D: arrived at PACU, E: 10 min after arrived at PACU, F: 30 min after arrived at PACU. PACU: post-anesthesia care unit.

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