Comparison of oxycodone and sufentanil in patient-controlled intravenous analgesia for postoperative patients: a meta-analysis of randomized controlled trials

Abstract

Abstract Background: Managing acute postoperative pain is challenging for anesthesiologists, surgeons, and patients, leading to adverse events despite making significant progress. Patient-controlled intravenous analgesia (PCIA) is a recommended solution, where oxycodone has depicted unique advantages in recent years. However, controversy still exists in clinical practice and this study aimed to compare two drugs in PCIA. Methods: We performed a literature search in PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, Chinese National Knowledge Infrastructure, Wanfang, and VIP databases up to December 2020 to select specific randomized controlled trials (RCTs) comparing the efficacy of oxycodone with sufentanil in PCIA. The analgesic effect was the primary outcome and the secondary outcome included PCIA consumption, the Ramsay sedation scale, patients’ satisfaction and side effects. Results: Fifteen RCTs were included in the meta-analysis. Compared with sufentanil, oxycodone showed lower Numerical Rating Scale scores (mean difference [MD] = −0.71, 95% confidence interval [CI]: −1.01 to −0.41; P < 0.001; I 2 = 93%), demonstrated better relief from visceral pain (MD = −1.22, 95% CI: −1.58 to −0.85; P < 0.001; I 2 = 90%), promoted a deeper sedative level as confirmed by the Ramsay Score (MD = 0.77, 95% CI: 0.35–1.19; P < 0.001; I 2 = 97%), and resulted in fewer side effects (odds ratio [OR] = 0.46, 95% CI: 0.35–0.60; P < 0.001; I 2 = 11%). There was no statistical difference in the degree of patients’ satisfaction (OR = 1.13, 95% CI: 0.88–1.44; P = 0.33; I 2 = 72%) and drug consumption (MD = −5.55, 95% CI: −14.18 to 3.08; P = 0.21; I 2 = 93%). Conclusion: Oxycodone improves postoperative analgesia and causes fewer adverse effects, and could be recommended for PCIA, especially after abdominal surgeries. Registration: PROSPERO; https://www.crd.york.ac.uk/PROSPERO/; CRD42021229973.