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Early oral analgesia after fast-track cardiac anesthesia

[L’analgésie orale précoce après la technique accélérée d’anesthésie cardiaque]

Alexander Kogan, MD^*, Benjamen Medalion, MD^*, Ehud Raanani, MD^*, Erez Sharoni, MD^*, Alon Stamler, MD^*, Natalia Pak, MD, Bernardo A. Vidne, MD^* and Leonid A. Eidelman, MD

^* From the Departments of Cardiothoracic Surgery and
Anesthesiology, Rabin Medical Center, Beilinson Campus, Petah Tiqwa, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Address correspondence to: Dr. A. Kogan, Department of Cardiothoracic Surgery, Rabin Medical Center, Beilinson Campus, Petah Tiqwa 49100, Israel. Phone: +972-3-9376701; Fax: +972-3-9240762; E-mail: alexanderkogan140{at}hotmail.com

Purpose: Oral analgesia after "fast-track" cardiac anesthesia has not been explored. The aim of this study was to compare two oral oxycodone analgesic regimens.

Methods: One hundred-twenty patients scheduled for coronary artery bypass grafting were randomly assigned postoperatively to receive immediate-release oxycodone 5 mg and acetaminophen 325 mg (Percocet-5) (group I) per os four times daily, or controlled-release oxycodone 10 mg (OxyContin) (group II) per os every 12 hr and placebo twice daily. Acetaminophen 500 mg per os was used as first-line rescue medication, and immediate-release oxycodone (syrup form) 5 mg per os as second-line rescue medication. Pain intensity was assessed with a visual analogue scale on the first postoperative day, the morning after extubation, and thereafter four times daily for four days. Use of rescue medication and adverse events were recorded.

Results: Baseline demographic and operation-related characteristics were similar in both groups. While pain control was good in both groups, the immediate-release group experienced less pain on all postoperative days (P = 0.003), required significantly less rescue medication, and had fewer adverse effects such as somnolence and nausea.

Conclusion: Peroral oxycodone is effective for early pain control after fast-track cardiac anesthesia. Immediate-release oxycodone/ acetaminophen appears to provide better analgesia and fewer side effects compared to controlled-release oxycodone.