Effect of Oxycodone Combined With Dexmedetomidine for Intravenous Patient-Controlled Analgesia After Video-Assisted Thoracoscopic Lobectomy

Abstract

Objective: To investigate the effect of the combination of oxycodone and dexmedetomidine for patient-controlled analgesia (PCA) after video-assisted thoracoscopic (VATS) lobectomy.

Design: A prospective, randomized, double-blind, controlled trial.

Setting: Shandong Cancer Hospital and Institute in Jinan, China.

Participants: Eighty-four patients with lung cancer undergoing VATS lobectomies were recruited.

Interventions: Patients were randomly assigned to one of the following two groups: oxycodone and dexmedetomidine (group OD) or oxycodone alone (group O). Before induction of anesthesia, patients in group OD received 0.5 μg/kg, dexmedetomidine diluted to 20 mL with physiologic saline and infused for 10 minutes intravenously. The PCA protocol was 50 mg of oxycodone and 0.05 μg/kg/h dexmedetomidine diluted to 100 mL. Patients in group O received 20 mL of physiologic saline infused for 10 minutes. Their PCA protocol consisted of 50 mg of oxycodone diluted to 100 mL. Intravenous PCA was used for postoperative analgesia (lasting for 48 h).

Measurements and main results: Pain at rest and during movement was assessed by a blinded observer using the Visual Analog Scale pain score (VAS) at 4, 6, 24, and 48 hours after surgery, and the level of sedation simultaneously was assessed using the Ramsay Sedation Scale. Total oxycodone consumption, requirements for rescue analgesia, side effects, and satisfaction with pain management were recorded within 48 hours after surgery. Eighty patients' data were analyzed at the end of the study (40 in each group). Visual Analog Scale scores decreased at 4, 6, and 24 hours at rest and during movement in group OD compared with group O (p<0.05). The level of patient satisfaction in group OD was significantly higher than that in group O (p<0.05). Oxycodone consumption in group OD was significantly lower than that in group O (p<0.001). Group O experienced more nausea and vomiting 6 hours after surgery than did group OD (p< 0.05).

Conclusion: The combination of oxycodone and dexmedetomidine for PCA after VATS lobectomy can reduce oxycodone consumption, improve patient satisfaction, and provide better analgesia with fewer side effects (nausea and vomiting) compared with PCA with oxycodone alone.

Keywords: dexmedetomidine; oxycodone; pain; patient-controlled analgesia; video-assisted thoracoscopic lobectomy; α(2)-adrenergic receptor.