Pre-emptive use of prolonged release oxycodone/naloxone combo significantly reduces postoperative pain after total hip arthroplasty

Abstract

Background & Objective: The role of pre-emptive analgesia remains controversial. Targeting the end of the surgery, the needed serum levels of analgesic can be achieved using prolonged release preparations, reducing acute postoperative pain and related complications. We assessed the efficacy of pre-emptive intake of prolonged release oxycodone/naloxone combination tablets on postoperative pain. Methodology: We enrolled 152 patients who underwent an elective total hip arthroplasty under general anesthesia in the current study. The patients who prospectively received a tablet of prolonged release oxycodone 10 mg + naloxone 5 mg just before induction of general anesthesia, were categorized in the pre-emptive group (n = 76). The hospital records of 76 patients, already operated, and who did not receive any pre-emptive opioids before induction were included in the control group. Patients’ postoperative pain was measured on the Numerical Rating Scale (NRS). Piritramide is routinely used in our hospital for postoperative pain titrated until NRS level of 3 or less is achieved. Study outcomes were; the dose of piritramide used, and the time spent in post anesthesia care unit (PACU). Results: Preoperative use of oxycodone/naloxone combination reduces the frequency of postoperative opioid use (25% vs. 7.8%; P = 0.007) and the piritramide usage (12 mg vs. 15 mg; P = 0.001) in the pre-emptive group compared to the control group. The number of patients who needed relatively small doses of piritramide (≤ 9 mg piritramide) was more in the pre-emptive group compared to the control group (44.7% vs 25%; P = 0.017). Conclusion: The pre-emptive use of oxycodone/naloxone combination is a safe and effective way to reduce postoperative pain after total hip arthroplasty. Abbreviations: NRS - Numerical Rating Scale; PACU - Post Anesthesia Care Unit; BMI - Body Mass Index; NSAIDs - Non-Steroidal Anti-inflammatory Drugs Key words: Analgesia, Pre-emptive; Oxycodone; Pain, Postoperative; Total Hip Arthroplasty Citation: Jocović J, Jocović M, Thieme M, Eberle T, Reppmann J. Pre-emptive use of prolonged release oxycodone/naloxone combination significantly reduces postoperative pain after total hip arthroplasty. Anaesth. pain intensive care 2023;27(4):464−469; DOI: 10.35975/apic.v27i4.2150 Received: February 06, 2023; Reviewed: March o3, 2023; Accepted: June 06, 2023