Oral opioid use sufficient following cardiac surgery
medwireNews: Oral opioids are as effective as intravenous (iv) opioids for relieving pain in patients who have undergone cardiac surgery, randomized trial findings show.
This suggests that oral opioids are sufficient even after very painful procedures and at an early postoperative stage, says the team, led by Kurt Ruetzler (University Hospital, Zurich, Switzerland).
“The oral administration of controlled-release tablets is not generally recommended during the initial postoperative day because of concerns about delayed drug absorption in the presence of decreased gastric emptying,” the researchers explain in the Journal of Anesthesia. “However, we found oral administration to be effective.”
They add that this is consistent with previous studies that found oral opioids improved outcomes after orthopedic and total hip replacement surgery.
A total of 50 patients having elective cardiac surgery and sternotomy were studied, of whom 24 were randomly assigned to receive oral opioids after rapid postoperative respiratory weaning, while 26 were randomly assigned to receive patient-controlled iv opioids.
They found that at a significantly lower morphine-equivalent dose, of 34 mg versus 69 mg, oral opioid administration was associated with similar pain scores on a visual analog scale to iv opioid administration.
The mean pain scores after taking into account variables such as age, body mass index, and type and duration of surgery were 18 points for the oral opioid group and 14 points for the iv opioid group.
The researchers note that the two groups did not differ with regard to the spontaneous respiratory rate or the likelihood for being deeply sedated, and they had comparable odds for experiencing side effects, such as nausea, dizziness, and headache. The only exception was vomiting which was less likely to occur in patients taking oral rather than iv opioids.
Given their findings, together with the fact that oral administration of opioids is convenient and non-invasive, the researchers hypothesize that early oral administration following cardiac surgery could help reduce healthcare costs.
medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2014
By Lucy Piper, Senior medwireNews Reporter