Abstract
PurposeThe optimal postoperative analgesia after cesarean section (CS) remains to be determined. The primary objective of this study was to assess whether oral oxycodone provides the same or better pain control and satisfaction with pain relief as oxycodone given intravenously using a patient-controlled analgesia (PCA) infusion device. The secondary objectives were to compare the gastrointestinal symptoms and postsurgical recovery of the two groups.MethodsThis prospective randomized trial was conducted at a University Hospital between February 2015 and June 2017. Altogether 270 CS patients were randomly assigned to receive postoperative oxycodone pain relief by IV PCA (n = 133) or orally (n = 137). Pain control and satisfaction with pain treatment were assessed by a numeric rating scale (NRS) at 2, 4, 8, and 24 h postoperatively.ResultsNo differences were found in NRS pain scores or satisfaction between the groups except at 24 h pain when coughing; there was a statistically significant difference favoring the IV PCA group (p = 0.006). In the IV PCA group, the patients experienced more nausea at 4 h (p = 0.001) and more vomiting at 8 h (p = 0.010). Otherwise, postoperative recovery was similar in both groups. The equianalgesic dose of oxycodone was significantly smaller in the oral group (p = 0.003).ConclusionsThis study indicates that oral oxycodone provides pain control and satisfaction with pain relief equal to IV oxycodone PCA for postoperative analgesia after cesarean section. Satisfaction with pain treatment was high in both groups, and both methods were well tolerated. Early nausea was less common with oral medication.
Highlights
Cesarean section (CS) is one of the most common surgical operations in the world [1]
Epidural analgesia was used for one patient in the IV patient-controlled analgesia (PCA) group, and two patients in the IV PCA group were given extra oxycodone for intolerable pain
In the IV PCA group, the mean consumption of iv oxycodone was 58.2 mg (SD 23.5), while in the oral group, the mean counted equianalgesic dose was 48.3 mg (SD 11.8) during the first 24 h (p = 0.003). In this prospective randomized study, we found that oral oxycodone was an effective and satisfactory means for postoperative analgesia after uncomplicated cesarean section as IV oxycodone administered by a patient-controlled device (PCA)
Summary
Cesarean section (CS) is one of the most common surgical operations in the world [1]. The CS rate reaches over 40% [2, 3]. In Finland, the CS rate has remained low at about 16.7% [4]. Pain relief after CS is crucial, and it affects both the mother and child. Poor pain relief may adversely affect recovery, mother–infant bonding, and breast-feeding; it may even lead to persistent postsurgical pain. Pain after CS was ranked ninth for pain severity among 179 surgical procedures in a study of 115,775 patients [5]. There are variable methods to manage postoperative pain, and the search for the ideal method is still ongoing. The use of opioids via different routes is the gold standard, several other techniques have been proposed [6]
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