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A randomised trial of oral versus intravenous opioids for treatment of pain after cardiac surgery

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Abstract

Background

Cardiac surgery and sternotomy are procedures accompanied by substantial postoperative pain which is challenging to treat. In general, intravenous (IV) opioids are used in the immediate postoperative phase, followed by oral opioids. Oral opioids are easier to use and generally less expensive. Our goal was thus to determine whether a new opioid preparation provides adequate analgesia after sternotomy. In particular, we tested the primary hypothesis that total opioid use (in morphine equivalents) is not greater with oral opioid compared with patient-controlled IV morphine. Our secondary hypothesis was that analgesic efficacy is similar with oral and IV opioids.

Methods

A total of 51 patients having elective cardiac surgery were enrolled in this study. After rapid postoperative respiratory weaning, the patients were randomised into one of two groups receiving different types of analgesia: oral Targin (a combination of oxycodone–hydrochloride and the opioid antagonist naloxone hydrochloride-dihydrate) or patient-controlled IV morphine. Pain score (visual analogue scale), sedation (Ramsey score), respiratory rate and side effects were assessed at 3, 5, 7, 9 and 11 h after surgery, and every 6 h throughout the third postoperative evening.

Results

The total opioid dose in morphine equivalent doses was significantly lower with oral opioid than with IV morphine (adjusted geometric means [95 % confidence interval]: 34 [29; 38] vs. 69 [61; 78] mg, respectively). Pain scores were similar in each group.

Conclusions

Analgesic quality was comparable with oral and IV opioids, suggesting that postoperative pain even after very painful procedures can be sufficiently managed with oral opioids.

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Acknowledgments

We thank the nursing team of the ICU 13B for their enthusiastic support.

Conflict of interest

Funded by internal sources only. None of the authors has any personal financial interest in this research.

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Authors and Affiliations

  1. Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria

    Kurt Ruetzler, Constance J. Blome, Sabine Nabecker, Henrik Fischer, Harald Rinoesl & Herbert Koinig

  2. Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland

    Kurt Ruetzler

  3. Departments of Quantitative Health Sciences and Outcomes Research, Cleveland Clinic, Cleveland, USA

    Natalya Makarova

  4. Department of Outcomes Research, Cleveland Clinic, Cleveland, USA

    Daniel I. Sessler

  5. Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria

    Georg Goliasch

  6. Department of Anaesthesia, Hospital Krems, Krems, Austria

    Herbert Koinig

Authors
  1. Kurt Ruetzler
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  2. Constance J. Blome
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  3. Sabine Nabecker
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  4. Natalya Makarova
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  5. Henrik Fischer
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  6. Harald Rinoesl
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  7. Georg Goliasch
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  8. Daniel I. Sessler
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  9. Herbert Koinig
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Corresponding author

Correspondence to Kurt Ruetzler.

Additional information

This study was registered at clinicaltrials.gov (NCT01816581).

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Ruetzler, K., Blome, C.J., Nabecker, S. et al. A randomised trial of oral versus intravenous opioids for treatment of pain after cardiac surgery. J Anesth 28, 580–586 (2014). https://doi.org/10.1007/s00540-013-1770-x

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  • DOI: https://doi.org/10.1007/s00540-013-1770-x

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