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Current Medicinal Chemistry


ISSN (Print): 0929-8673
ISSN (Online): 1875-533X

Research Article

Analgesic Efficacy and Safety of Spinal Oxycodone in Total Hip Arthroplasty: A Preliminary Study

Author(s): Grzegorz Kowalski, Bogumił Olczak, Wojciech Leppert*, Agnieszka Bienert, Artur Teżyk, Danuta Szkutnik-Fiedler, Michał Adamski and Katarzyna Wieczorowska-Tobis

Volume 29, Issue 21, 2022

Published on: 30 March, 2022

Page: [3806 - 3814] Pages: 9

DOI: 10.2174/0929867329666220126125256

Price: $65


Aim: The aim of this study was to assess the analgesic efficacy and safety of 1 mg and 0.5 mg oxycodone administration in a spinal block procedure for a total hip arthroplasty (THA).

Patients and Methods: Forty-two THA patients aged 59-81 with American Society Anesthesiology (ASA) II-III were included. All patients received anesthesia using spinal blockade, with bupivacaine 0.5% spinal heavy 2.5 ml, with 0.5 ml oxycodone hydrochloride 1.0 mg (group A; n = 28) or 0.5 mg (group B; n = 14). During surgery, each patient was sedated with 2-4 mg/kg/h intravenous propofol infusion. They received 100 mg intravenous ketoprofen at the end of the surgery at 8 pm and 8 am, with recommended doses every 12 h thereafter. Subcutaneous morphine 5 mg was used as a rescue analgesic, and the time to morphine use was recorded. After surgery, pain intensity (at the moment of patient report) was assessed using an 11-point numerical rating scale (NRS). The incidence of adverse effects was monitored. Blood samples were taken for assays of serum oxycodone, noroxycodone and bupivacaine levels.

Results: The time to rescue analgesia was 9.6 ± 5.6 h in group A and 7.3 ± 1.9 h in group B, and it did not differ between patient groups (P = 0.179). The mean NRS pain score was 4.5 in group A and 4.2 in group B. Three group A patients had detectable oxycodone levels: two < 7.1 ng/ml and in 1 spinal block induced anesthesia was unsuccessful and so he/she underwent general anesthesia (this patient was excluded from the analysis). Four group B patients had single values < 5 ng/ml. Noroxycodone levels were in all patients undetectable, and bupivacaine levels were 70-300 ng/ml. Regarding adverse effects, one patient had hypotension, one had bradycardia, and one had pruritus.

Conclusion: Oxycodone in spinal block prolongs analgesia period, does not cause serious adverse effects and seems to be safe and effective opioid for patients undergoing THA.

Keywords: Adverse effects, anesthesia, analgesia, opioid, oxycodone, pain, treatment.

« Previous
Khanduja, V. Total hip arthroplasty in 2017 - Current concepts and recent advances. Indian J. Orthop., 2017, 51(4), 357-358.
[] [PMID: 28790463]
HCPUnet. Healthcare cost and utilization project. Agency for healthcare research and quality. Available from: (Accessed on: 24th July 2021).
Brill, S.; Gurman, G.M.; Fisher, A. A history of neuraxial administration of local analgesics and opioids. Eur. J. Anaesthesiol., 2003, 20(9), 682-689.
[] [PMID: 12974588]
Yoganarasimha, N.; Raghavendra, T.; Amitha, S.; Shridhar, K.; Radha, M. A comparative study between intrathecal clonidine and neostigmine with intrathecal bupivacaine for lower abdominal surgeries. Indian J. Anaesth., 2014, 58(1), 43-47.
[] [PMID: 24700898]
Bani-Hashem, N.; Hassan-Nasab, B.; Pour, E.A.; Maleh, P.A.; Nabavi, A.; Jabbari, A. Addition of intrathecal dexamethasone to bupivacaine for spinal anesthesia in orthopedic surgery. Saudi J. Anaesth., 2011, 5(4), 382-386.
[] [PMID: 22144925]
Murali Krishna, T.; Panda, N.B.; Batra, Y.K.; Rajeev, S. Combination of low doses of intrathecal ketamine and midazolam with bupivacaine improves postoperative analgesia in orthopaedic surgery. Eur. J. Anaesthesiol., 2008, 25(4), 299-306.
[] [PMID: 17892610]
Rauck, R.; Coffey, R.J.; Schultz, D.M.; Wallace, M.S.; Webster, L.R.; McCarville, S.E.; Grigsby, E.J.; Page, L.M. Intrathecal gabapentin to treat chronic intractable noncancer pain. Anesthesiology, 2013, 119(3), 675-686.
[] [PMID: 23835590]
Yaksh, T.L.; Rudy, T.A. Analgesia mediated by a direct spinal action of narcotics. Science, 1976, 192(4246), 1357-1358.
[] [PMID: 1273597]
Bujedo, B.M.; Santos, S.G.; Azpiazu, A.U. A review of epidural and intrathecal opioids used in the management of postoperative pain. J. Opioid. Manag., 2012, 8(3), 177-192.
[] [PMID: 22798178]
Wang, J.K.; Nauss, L.A.; Thomas, J.E. Pain relief by intrathecally applied morphine in man. Anesthesiology, 1979, 50(2), 149-151.
[] [PMID: 373503]
Mugabure Bujedo, B. A clinical approach to neuraxial morphine for the treatment of postoperative pain. Pain Res. Treat., 2012, 2012, 612145.
[] [PMID: 23002426]
Plummer, J.L.; Cmielewski, P.L.; Reynolds, G.D.; Gourlay, G.K.; Cherry, D.A. Influence of polarity on dose-response relationships of intrathecal opioids in rats. Pain, 1990, 40(3), 339-347.
[] [PMID: 2326098]
Pöyhiä, R.; Kalso, E.A. Antinociceptive effects and central nervous system depression caused by oxycodone and morphine in rats. Pharmacol. Toxicol., 1992, 70(2), 125-130.
[] [PMID: 1508838]
Attri, J.P.; Gupta, K.K.; Khetarpal, R. Emerging trends of sedation during regional anesthesia. Anaesth. Pain Intensive Care, 2015, 19, 527-532.
Backlund, M.; Lindgren, L.; Kajimoto, Y.; Rosenberg, P.H. Comparison of epidural morphine and oxycodone for pain after abdominal surgery. J. Clin. Anesth., 1997, 9(1), 30-35.
[] [PMID: 9051543]
Yanagidate, F.; Dohi, S. Epidural oxycodone or morphine following gynaecological surgery. Br. J. Anaesth., 2004, 93(3), 362-367.
[] [PMID: 15220165]
Piirainen, P.; Kokki, H.; Hautajärvi, H.; Ranta, V.P.; Kokki, M. The analgesic efficacy and pharmacokinetics of epidural oxycodone after gynaecological laparotomy: A randomized, double-blind, double-dummy comparison with intravenous administration. Br. J. Clin. Pharmacol., 2018, 84(9), 2088-2096.
[] [PMID: 29782641]
Lugo, R.A.; Kern, S.E. The pharmacokinetics of oxycodone. J. Pain Palliat. Care Pharmacother., 2004, 18(4), 17-30.
[] [PMID: 15760805]
Olczak, B.; Kowalski, G.; Leppert, W.; Bienert, A.; Teżyk, A.; Adamski, M.; Rzymski, S.; Wieczorowska-Tobis, K. Analgesic efficacy and safety of epidural oxycodone in patients undergoing total hip arthroplasty: A pilot study. J. Pain Res., 2017, 10, 2303-2309.
[] [PMID: 29026333]
Dillane, D.; Finucane, B.T. Local anesthetic systemic toxicity. Can. J. Anaesth., 2010, 57(4), 368-380.
[] [PMID: 20151342]
Atef, H.; El-Kasaby, A.; Omera, M.; Badr, M. Optimal dose of hyperbaric bupivacaine 0.5% for unilateral spinal anesthesia during diagnostic knee arthroscopy. Local Reg. Anesth., 2010, 3, 85-91.
[] [PMID: 22915874]
Kotwani, M.; Kanchan, R.; Prashanth, S.; Jyoti, M. Comparison between high dose hyperbaric Bupivacaine (12.5 mg) alone versus low dose hyperbaric Bupivacaine (7.5 mg) with Fentanyl (25 µg) in spinal anaesthesia for inguinal hernia surgery. Int. J. Clin. Trials, 2016, 3, 140-146.
Olczak, B.; Kowalski, G.; Leppert, W.; Zaporowska-Stachowiak, I.; Wieczorowska-Tobis, K. Analgesic efficacy, adverse effects, and safety of oxycodone administered as continuous intravenous infusion in patients after total hip arthroplasty. J. Pain Res., 2017, 10, 1027-1032.
[] [PMID: 28496358]
Pöyhiä, R.; Olkkola, K.T.; Seppälä, T.; Kalso, E. The pharmacokinetics of oxycodone after intravenous injection in adults. Br. J. Clin. Pharmacol., 1991, 32(4), 516-518.
[] [PMID: 1958450]
Helwani, M.A.; Avidan, M.S.; Ben Abdallah, A.; Kaiser, D.J.; Clohisy, J.C.; Hall, B.L.; Kaiser, H.A. Effects of regional versus general anesthesia on outcomes after total hip arthroplasty: A retrospective propensity-matched cohort study. J. Bone Joint Surg. Am., 2015, 97(3), 186-193.
[] [PMID: 25653318]
Tey, H.L.; Wallengren, J.; Yosipovitch, G. Psychosomatic factors in pruritus. Clin. Dermatol., 2013, 31(1), 31-40.
[] [PMID: 23245971]
Liu, X.; Zhang, J.; Zhao, H.; Mei, H.; Lian, Q.; ShangGuan, W. The effect of propofol on intrathecal morphine-induced pruritus and its mechanism. Anesth. Analg., 2014, 118(2), 303-309.
[] [PMID: 24445631]
Glass, P.S. Respiratory depression following only 0.4 mg of intrathecal morphine. Anesthesiology, 1984, 60(3), 256-257.
[] [PMID: 6546481]
Leppert, W. Role of oxycodone and oxycodone/naloxone in cancer pain management. Pharmacol. Rep., 2010, 62(4), 578-591.
[] [PMID: 20884999]

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