Comparative Time Achieved VAS ≤ 3 On Oxycodone And Fentanyl

Intravenous Continue as Post-Operative Analgesia

Kumar Virat, Hanafie Achsanuddin, Arifin Hasanul, Nasution Akhyar H.
Anesthesiology and Intensive Therapy Faculty of Medicine of North Sumatra

ABSTRACT:

Background: Fentanyl has a potency ratio 100 times stronger than morphine. Oxycodone is a receptor agonist
of mu and kappa opioid, structurally similar to codeine, but pharmacodynamically similar to morphine.
Objective: To find out the comparison of time achievement of VAS ≤ 3 on oxycodone.
Methods: This study was using double-blind randomized clinical trials, collected 48 samples, ages 21-60
years, PS ASA I-II. Oxycodone (A) : Fentanyl (B) (initial bolus 5 mg than continuous infusion dose of 1
mg/hour : initial bolus 5 cc of NaCl 0.9% than continuous infusion dose of 0.5 mcg/hour). with significance
level 95% (p <0,05).
Results: Average length of surgery Fentanyl : Oxycodone (218.96 ± 53.38 minutes : 191.87 ± 80.10,
p> 0.05).
Conclusion: Oxycodone is faster in achieving VAS≤3 compared with Fentanyl intravenous intravenous infu-
sion.

Keywords: Oxycodone, Fentanyl, Opiates, Visual Analogue Score, Effectiveness

after the administration of Oxycodonedosis 1 mg /

1. INTRODUCTION
Fentanyl has a potential ratios 100 times stronger
than morphine. (Barash, 2013) The South African
Anesthesiologist's Guide with the average fentanyl
dose for postoperative pain is 1-5 mcg / kg / day.
(SASA, 2009)
Opioid drugs are most commonly used in the
first 24 hours postoperatively during the patient. Pa-
tients who have frequently received previous opioid
administration may become resistant to commonly
used opioid doses. (Fabregat, 2011)
Kloub in 2015 examined the efficacy of Oxyco-
done for the treatment of short-term pain in postop-
erative patients. The result was 263 patients studied
with various surgical procedures. It was reported
that 220 patients (83.7%) had no pain and 20 pa-
tients (7.6%) reported pain with a score of five more
than those concluded. Oxycodone is effective in the
treatment of short-term pain in most types of sur-
gery. (Kloub, 2015)
Park in 2015 studied 74 patients undergoing
elective laparoscopic hysterectomy or laparoscopic
laparoscopic myomectomy with a random choice to
obtain fentanyl or Oxycodone using IV-PCA (po-
tential ratio 1:60). Patients were also examined for
postoperative pain, side effects, and patient satisfac-
tion; there was a significant difference in patient
satisfaction observation with analgesics during the
postoperative period. Patients in the Oxycodone
group showed a low intake of opioids (10.1 ± 8.5 ml
vs. 16.6 ± 12.0 ml, P = 0.013) It was found that Ox-
ycodone and fentanyl showed similar effects (Park
2015) differences in VAS values and adverse events
hour and fentanyl dose 0.5 mcg / kgbb / hour intra-
venously continuously in overcoming post-surgical
pain of long bone surgery under general anesthesia
on the grounds of finding alternatives to opioid an-
algesic drugs that have an effect the same for post-
operative pain management with general anesthesia
techniques without side effects that could harm the
patient.
2. METHODS
The design of this study used a double-blind, ran-
domized controlled clinical trial. To determine dif-
ferences in VAS values and adverse events after ox-
ycodonedosis 1 mg / hour and fentanyl doses of 0.5
mcg / kgbb / hr of intravenous continuous pain in
post-surgical pain with general anesthesia. This re-
search was conducted at RSUP.H. Adam Malik. Re-
search was conducted after the ethical clearance was
published until the number of samples was met.
The study population was all elective patients
scheduled to undergo long bone surgery under gen-
eral anesthesia techniques using ETT. The study
sample fulfilled inclusion and exclusion criteria.
Once calculated statistically, all samples are divided
into:
a.Group A received oxycodonebolus 5 cc and
continued with an intravenous continuous 1 cc / hour
continuous maintenance dose.
b. Group B received fentanyl doses of 0.5 mcg /
kgbb continuous intravenously.
Inclusion Criteria: Age 21-60 years, patients un-
dergoing long bone surgery, physical status of ASA
 1 and 2, with ideal body weight according to BMI, (10,4%)
patients agree to participate in the study. Exclusion  40 – 49 4 (16,7%) 6 (25,0%) 10
Criteria: Patients who received opioid analgesics (20,8%)
prior to surgery. Criteria of Disconnect Test (Drop  50 – 59 6 (25%) 9 (37,5%) 15
(31,3%)
Out): Occurred emergency heart and lung, allergic Total 24 (100%) 24 (100%) 48
reactions occur after the use of drugs studied. (100%)
Patient gets an explanation about the procedure to 2. Sex
be followed and states informed consent. Both  Male 13 15 (62,5%) 28
groups of patients were given preloading fluid Ring- (54,2%) (58,3%)
0,558
er Lactate 10 ml / kgBW. Both groups were pre-  Female 11 9 (37,5%) 20
pared for general anesthesia. Premedication with (45,8%) (41,7%)
fentanyl 2 mcg / kg, midazolam 0.05 mg / kg, await- Total 24 (100%) 24 (100%) 48
ed onset 5 minutes. Patients were induced with (100%)
propofol 2 mg / kg, rocuronium muscle paralytic 3. ASA
1
 ASA 1 10 8 (33,3%) 19
mg / kg, after onset of 1 min, direct laryngoscopy (41,7%) (39,6%)
was performed with laryngoscope and trachea was 0,551
 ASA 2 14 16 (66,7%) 29
intubated with appropriate size endotracheal tubes. (58,3%) (60,4%)
Surgery begins, the maintenance of sedation using Total 24 (100%) 24 (100%) 48
Isoflurane, maintenance of analgesia with fentanyl (100%)
according to hemodynamic response, and mainte- *Fisher exact test.
nance of muscle paralysis using rocuronium. Statistically did not show any significant differ-
After surgery, after the patient fulfilled the extu- ences in age, sex and ASA between the two study
bation criteria, the patient was extubated and the groups (p> 0.05).
time was recorded as T0, and VAS was assessed us-
ing the VAS drawing table, asked to the patient by Distribution of Research Subjects based on preoper-
showing the scale corresponding to the perception of ative VAS values
pain felt by the patient. This assessment is done di- VAS Pre Drugs p
Total
rectly by researchers who are not involved in the Op Fentanyl Oxycodone Value*
4 15 (62,5%) 11 (45,8%) 26 (54,2%)
administration of drugs in these patients. The time of 0,247
5 9 (37,5%) 13 (54,2%) 22 (45,8%)
initiation of the study in which group A received ox- 24 24 48
ycodonebolus 5 mg was followed by intravenous 1 Total
(100,0%) (100,0%) (100,0%)
mg / hour continuous maintenance for 24 hours, *Chi-Square Tests
while group B received fentanyl with the initial bo- Statistically, there was no significant difference in
lus using 0.9% NaCl 0.5 ccdosis of 0.5 mcg / kgbb / preoperative VAS between the two study groups (p>
hour intravenous for 24 hour. If during the course of 0.05).
the study the patient is still painful (VAS> 3) then
oxycodone will be increased 1 mg per hour until The Average Difference In The Duration of Surgery
VAS <3 is reached. The fentanyl drug will be in- Based On The Given Drug
creased by 0.5 mcg to VAS <3.
The patient will be observed in the recovery room
Duration of Operation (Minutes)
and transferred to the ward when the Aldrette Score Val
was 10. The VAS assessment and the side effects of Drugs Std. ue
nMea De- Me- Mini- Max-
the drug were performed directly by the researchers given of
n via- dian mum imum
at 0 (T0), 1 (T1), 2 (T2), 3 (T3), 4 (T4), 6 (T5), 12 p*
(T6) and 24 (T7) after surgery ends. T0 begins after tion
the patient is extubated and fully awake. The results Fenta- 2218, 217,
53,38 50 310
of observational data in both groups were statistical- nyl 4 96 5 0,1
ly comparable. Oxyco- 2191, 80,99 85
200 65 365
done 4 87 7
*Mann-Whitney test
3. RESULTS Based on the above table, it can be seen that the
average duration of group operation given Fentanyl
Distribution of Research Subjects by Age, Sex, was 218.96 ± 53.38 minutes and the mean duration
ASA of group operation given Oxycodone was 191.87 ±
Characteristics Drugs given Total p 80.10 minutes. Based on statistical tests with Mann-
Morphine Oxycodone Value
Whitney test showed no difference in the duration of
1. Age (year)
surgery between the two study subjects (p> 0.05).
 19 – 29 11 7 (29,2%) 18
(45,8%) (37,5%) 0,604
 30 – 39 3 (12,5%) 2 (8,3%) 5
 The average time difference to achieve VAS ≤3 compared with the fentanyl group with an average
based on the given drugs time of 2.58 hours. Mann-Whitney test results in this
Time to reach VAS 3 (Hours) Val study also showed that the average dose of drugs
Drugs Std. ue produced in the Oxycodone group had a smaller
nMe Me- Mini- Max- dose range of 1.46 ± 0.51 mg compared with fenta-
Given Devia- of
an
tion
dian mum imum p* nyl of 0.4058 ± 0.054 mcg.
2 2,5
A study conducted by KIM in 2014 found that
Fentanyl
4 8
0,50 3 2 3
0,0
Oxycodone IV-PCA was more favorable than IV-
Oxyco- 2 1,4 01
PCA fentanyl for laparoscopic hysterectomy surgery
done 4 6
0,509 1 1 2 in terms of oxycodone consumption accumulation,
pain control and favorable effects related to price.
*Mann-Whitney test
This is in line with this study, where the use of Ox-
Based on statistical tests with Mann-Whitney test
ycodone by continuous infusion is more effective in
showed no time difference to achieve VAS≤ 3 be-
reducing VAS ≤3 compared with fentanyl use.
tween the two study subjects (p <0.05).
This study did not assess the incidence of adverse
events occurring from both drugs. In further studies,
Average VAS Score of Oxycodone and Fentanyl T0- an assessment of possible side effects may be
T7 Groups possible due to the use of this drug.

6
4
2
0 Choi Yoon-Ji, Park Sang-Wook, Kwon Hyun-Jung, dkk.
T0 T1 T2 T3 T4 T6 T12 T24
Oxycodone Fentanyl
From the graph above, the oxycodone group has a
lower average VAS value compared to the fentanyl
group in T1 - T7. In T0 both groups have the same
VAS. This is because there are still effects of anal-
gesic drugs used during surgery.
4. DISCUSSION
This study assessed the effectiveness of Oxyco-
done analgesics and continuous infusion fentanyl in
monitoring post-operative pain in long bones. From
the sample characteristic data it can be seen that the
age between the two sample groups did not have sta-
tistically significant difference, thus the samples tak-
en were relatively homogeneous (p> 0.05). Similar-
ly, sex, ASA physical stattus, VAS Pre op and
duration of operation between the two groups of
samples were not statistically significant (p> 0.05).
Based on statistical test of the average dose used
to achieve VAS ≤ 3 it was found that the mean dose
of fentanyl group drug group was 0.4058 ± 0.054
mcg more than the group given Oxycodone as much
as 1.46 ± 0.51 mg. Statistical tests with MANN
Whitney test showed significant differences between
the two groups (p <0.05).
The results of clinical trials showed that the Ox-
ycodone group proved to require a faster time to
achieve VAS ≤ 3 with a mean time of 1.46 hours
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