| Objective:Laparoscopic hysterectomy with or without bilateral salpingo-oophorectomy(LH w/o BSO)is one of the most common gynecologic procedures.Although LH w/o BSO is a minimally invasive procedure with fast postoperative recovery,patients still complain moderate to severe postoperative pain.Our object is to compare the difference in acute&chronic postoperative pain and overall recovery quality between the intraoperative use of oxycodone and fentanyl in LH w/o BSO,and to optimize perioperative analgesic regimen.Methods:This is a prospective,single-blind,randomized controlled clinical trial.Patient who had elective LH w/o BSO at Pecking Union Medical College Hospital from December 2017 to April 2018 were enrolled.They were randomly assigned to either oxycodone group(group O),or fentanyl group(group F).0.1 mg/kg oxycodone hydrochloride or 1～μg/kg fentanyl citrate was used for induction.Additional oxycodone or fentanyl was added based on the duration of surgery and changes of patient’s vital signs.Remifentanil was continuously infused in both groups.Acute postsurgical pain was assessed at five time points including 0 to 0.5 hours(Tl),1 to 3 hours(T2),3 to 6 hours(T3),20 to 30 hours(T4),and 40 to 50 hours(T5).Chronic postsurgical pain(CPSP)was assessed at 2 months after surgery.The primary outcome was numerical rating scale for visceral pain within 2 days after surgery.Secondary outcome included incidence of moderate-to-severe pain,opioid use,numerical rating scale of nausea,score of 9-item quality of recovery scoring system(QoR-9)within 2 days after surgery,length of postoperative hospital stay,and incidence of CPSP 2 months postoperatively.Data were collected and analyzed using IBM SPSS Statistics 22.0.Results:(1)120 patients were enrolled in this study and 82 of them completed 2-day follow-up(42 in group F,40 in group O),49 of them completed 2-month follow-up(28 in group F,21 in group O).There was no significant difference in age,body mass index,previous history,surgical methods,preoperative diagnosis,and preoperative pain.(2)Average consumption of oxycodone in group O was 9.82 mg per capita,and average consumption of fentanyl in group F was 252.68 μg per capita.There was no significant difference in the total remifentanil consumption between the two groups.There were no significant differences in terms of operative time,anesthesia time,resuscitation and extubation time,incidence of the respiratory depression in Post Anesthesia Care Unit(PACU)and PACU stay time between the two groups.(3)Oxycodone significantly reduced the numerical rating scale of visceral pain and incision pain at rest and movement within 2 days after operation.The difference at T4 and T5 were the most significant(T4,at rest 1.40±1.01 vs 3.37± 2.20,p<0.001,at movement 2.02±1.48 vs 4.01±2.08,p<0.001;T5,at rest 0.52±0.74 vs 1.76±1.80,p=0.004,at movement 1.12±1.08 vs 2.15±1.56,P=0.009).The proportion of moderate and severe visceral pain at T3,T4,and T5 in group O were lower than that in group F(T3,at rest 20%vs 43%,p=0.026,at movement 23%vs 55%,P=0.003;T4,at rest 5%vs 43%,p<0.001,at movement 13%vs 60%,p=0.001;T5,at rest 0%vs 19%,p=0.005,at movement 0%vs 21%,p=0.002),there were no significant differences in the numerical rating scale of shoulder pain and perineal pain in both groups,but the proportion of moderate to severe shoulder pain at rest at T4 in group O was lower(0%vs 24%,p=0.003).The use of oxycodone also reduced the proportion of postoperative analgesic drug use within 2 days after surgery(18%vs 43%,p=0.013).(4)No significant intergroup differences were observed in the numerical rating scale of nausea,proportion of antiemetic drug use,the time of first-flatus,and incidence of urinary retention within 2 days after surgery.(5)Oxycodone reduced the length of postoperative hospital stay(2.87±1.04 vs 3.84 ± 2.12,p=0.004).There were no significant differences in the QoR-9 scores,incidence of postoperative complications,and incidence of chronic pain syndrome two months postoperatively in both groups.Conclusion:Intraoperative use of oxycodone in LH w/o BSO was associated with a better postoperative analgesia effect and shorter hospital stay without increasing the incidence of postoperative complications,when compared to fentanyl. |
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