Frontiers in medicine · 2026
Efficacy of oxycodone in managing visceral pain among women undergoing repeat cesarean section: a randomized controlled trial.
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Chen Qiwei, Hu Shishi, Liu Jie, Duan Guangyou, Chen Mengjie, Li Shiqi
Аннотация
OBJECTIVE: The global cesarean section (CS) rate is on the rise, with ratio of repeat CS becoming more common in China following the two-child policy. Postoperative visceral pain, particularly intense in repeat CS parturients and exacerbated by oxytocin, remains inadequately managed. Oxycodone, acting via κ-opioid receptors, has shown promise in relieving visceral pain, but its efficacy in repeat CS populations is unclear, which was explored in this study.
METHODS: This randomized controlled trial enrolled 100 parturients undergoing elective repeat CS, randomized to patient-controlled intravenous analgesia (PCIA) with oxycodone (50 mg/100 ml) or sufentanil (100 μg/100 ml). Primary outcomes were maximum visceral pain Numerical Rating Scale (NRS) scores during 0-24 h postoperatively. Secondary outcomes included visceral pain NRS during oxytocin administration on postoperative days 1-2, postoperative inflammatory markers (neutrophil-to-lymphocyte ratio, NLR), time to autonomic activity and PCIA presses. This trial was registered with the Chinese Clinical Trial Registry (ChiCTR2400087624; July 31 2024).
RESULTS: Significantly lower maximum visceral pain NRS scores in the oxycodone group during 24h after surgery compared to sufentanil group (2.2 ± 0.6 vs. 3.4 ± 0.7, P < 0.001), and also at all time points during oxytocin infusion (P < 0.001). The oxycodone group also had shorter time to autonomic activity (23.7 ± 5.1 vs. 26.3 ± 3.4 h, P = 0.004), lower postoperative NLR (7.2 ± 2.1 vs. 9.1 ± 3.7, P = 0.003), and fewer PCIA presses (P = 0.002). Multivariate linear regression confirmed oxycodone as an independent predictor of reduced maximum postoperative pain (adjusted β = -1.13, 95%CI:-1.41 to-0.85, P < 0.001).
CONCLUSION: In conclusion, oxycodone effectively alleviates postoperative visceral pain and mitigates inflammatory responses in repeat CS parturients, making it a preferred choice for postoperative analgesia in this population.
METHODS: This randomized controlled trial enrolled 100 parturients undergoing elective repeat CS, randomized to patient-controlled intravenous analgesia (PCIA) with oxycodone (50 mg/100 ml) or sufentanil (100 μg/100 ml). Primary outcomes were maximum visceral pain Numerical Rating Scale (NRS) scores during 0-24 h postoperatively. Secondary outcomes included visceral pain NRS during oxytocin administration on postoperative days 1-2, postoperative inflammatory markers (neutrophil-to-lymphocyte ratio, NLR), time to autonomic activity and PCIA presses. This trial was registered with the Chinese Clinical Trial Registry (ChiCTR2400087624; July 31 2024).
RESULTS: Significantly lower maximum visceral pain NRS scores in the oxycodone group during 24h after surgery compared to sufentanil group (2.2 ± 0.6 vs. 3.4 ± 0.7, P < 0.001), and also at all time points during oxytocin infusion (P < 0.001). The oxycodone group also had shorter time to autonomic activity (23.7 ± 5.1 vs. 26.3 ± 3.4 h, P = 0.004), lower postoperative NLR (7.2 ± 2.1 vs. 9.1 ± 3.7, P = 0.003), and fewer PCIA presses (P = 0.002). Multivariate linear regression confirmed oxycodone as an independent predictor of reduced maximum postoperative pain (adjusted β = -1.13, 95%CI:-1.41 to-0.85, P < 0.001).
CONCLUSION: In conclusion, oxycodone effectively alleviates postoperative visceral pain and mitigates inflammatory responses in repeat CS parturients, making it a preferred choice for postoperative analgesia in this population.