Background: Early pain after laparoscopic surgery is often moderate to severe (1). Epidural oxycodone penetrates readily into cerebrospinal fluid and may be more potent than intravenous (i.v.) oxycodone (2). In this randomised, double blind clinical trial, we have assessed the analgesic efficacy of epidural oxycodone after gynaecologic laparoscopy.
Methods: We enrolled 60 women, aged 23-71 years, undergoing elective gynaecologic laparoscopy under standardized general anaesthesia. Postoperatively, the patients were administrated either i.v. saline and epidural oxycodone 0.1 mg•kg-1 (EPI-group, n=31) or i.v. oxycodone 0.1 mg•kg-1 and epidural saline (IV-group, n=29). For background analgesia the subjects received i.v. paracetamol and dexketoprofen. The primary outcome was the amount of i.v. fentanyl for rescue analgesia during the first four postoperative hours. Analysis of data was performed with independent samples t-test. Data is presented as number of cases or median (minimum – maximum).
Results: The median amount of fentanyl for rescue analgesia during the first four postoperative hours was 50 (0-450) µg in the EPI-group and 100 (0-550) µg in the IV-group, p=0.025. More patients had pruritus in the EPI-group than in the IV-group, 17 vs. 8, respectively, p=0.032.
Conclusion: Analgesic efficacy of epidural oxycodone was superior compared to that of i.v. administration in early pain management after laparoscopic surgery.