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We design this randomized controlled trial to compare the safety and efficacy of Oxycodone and Sufentanil for postoperative patient-controlled analgesia in patients undergoing hip surgery, with a view to finding the optimal postoperative analgesic regime with fewer adverse reactions and promoting patients' rehabilitation.
Hip surgery is a common type of orthopedic surgery. The pathologies are complex, including chronic conditions such as femoral head necrosis, primary hip dysplasia, hip joint osteoarthritis and rheumatoid arthritis, as well as acute diseases such as femoral neck fractures and intertrochanteric fractures. The surgical treatment includes closed reduction and internal fixation, open reduction and internal fixation, hemiarthroplasty (femoral head replacement), and total hip arthroplasty, etc. The population of patients undergoing hip surgery has a high proportion of elderly (>65 years old), with multiple preoperative comorbidities, and significant postoperative pain. We must achieve the balance between the providing sufficient analgesia and minimizing associated adverse reactions perioperatively for such group of patients, therefore promoting patients' rehabilitation.
Sufentanil, a pure μ receptor agonist with active metabolite, is a long-acting strong opioid which has high analgesic efficacy. It is commonly used in anesthesia practice, not only for intraoperative analgesia, but also postoperative pain relief, i.e. a popular drug of choice used for Patient Control Intravenous Analgesia (PCIA). However, sufentanil is associated with high incidence of postoperative nausea and vomiting (PONV), respiratory depression and other adverse reactions, which could negatively affect the patient's analgesic satisfaction, and compromise the course of postoperative recovery. It is important to establish an effective and safe postoperative analgesic regime that can achieve the comparable analgesic efficacy with reduced incidence of adverse reactions. Oxycodone is a semi-synthetic opioid which is extracted from the thebaine, it activates both μ and κ opioid receptors. It has been reported to have good analgesic effect and lower incidence of adverse reactions such as PONV in comparison with Morphine, and could be a reasonable option for PCIA. As Oxycodone can agonize κ receptors and reduce visceral pain, most of the existing studies on Oxycodone are focused on laparoscopic cholecystectomy and other abdominal surgeries, with the average age of study patients is between 40 to 55 years old, and also lack of large sample studies.
Based on the abovementioned literatures, we propose the hypothesis that in hip surgery, compared with Sufentanil PCIA, the equipotency dose of Oxycodone PCIA can achieve the same postoperative analgesic efficacy and may also reduce the incidence of adverse reactions associated with opioids.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Oxycodone group | Experimental | PCIA is formulated at 0.4 mg/ml of oxycodone. |
|
| Sufentanil group | Active Comparator | PCIA is formulated at 2 μg/ml of sufentanil. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Oxycodone Hydrochloride | Drug | Subjects will receive patient' controlled intravenous analgesia in analgesic pump with 0.4 mg/ml of oxycodone for postoperative analgesia. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Postoperative numerical rating scales (NRS) at rest | Resting NRS pain scores at 2 h after surgery. | Up to 72 hours after operation |
| Measure | Description | Time Frame |
|---|---|---|
| Incidence of post operative nausea and vomiting (PONV) | The proportion of subjects who experienced PONV | Up to 72 hours after operation |
| The severity of first PONV and the most severe PONV | The severity of PONV is scored from 0 to 10, and 0 represents no PONV at all, and 10 represents very severe PONV. |
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Inclusion criteria:
Exclusion criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Ren Liao, M.D | West China Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| West China Hospital, Sichuan University | Chengdu | Sichuan | 610041 | China |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 40095065 | Derived | Liao C, Zhu H, Zhong J, Lai X, Zhang B, Liao R. Patient Controlled Intravenous Analgesia with Oxycodone or Sufentanil After Hip Surgery: Study Protocol for a Multi-Centered, Randomized Controlled Trial. J Clin Med. 2025 Feb 25;14(5):1525. doi: 10.3390/jcm14051525. |
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| ID | Term |
|---|---|
| D000377 | Agnosia |
| ID | Term |
|---|---|
| D010468 | Perceptual Disorders |
| D019954 | Neurobehavioral Manifestations |
| D009461 | Neurologic Manifestations |
| D009422 | Nervous System Diseases |
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| ID | Term |
|---|---|
| D010098 | Oxycodone |
| D017409 | Sufentanil |
| ID | Term |
|---|---|
| D003061 | Codeine |
| D009022 | Morphine Derivatives |
| D009019 | Morphinans |
| D053610 | Opiate Alkaloids |
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| Sufentanil Citrate | Drug | Subjects will receive patient' controlled intravenous analgesia in analgesic pump with 2 μg/ml of sufentanil for postoperative analgesia. |
|
| Up to 30 days after operation |
| Time from the end of operation to the first onset of PONV | Time from the end of operation to the first onset of PONV | Up to 30 days after operation |
| Postoperative numerical rating scales (NRS) at rest | Postoperative resting NRS pain scores at 30 min, 6h, 24h, 48h, and 72h after the surgery | Up to 72 hours after operation |
| Postoperative NRS on movement | Postoperative NRS pain score on movement, up to 72hr. | Up to 72 hours after operation |
| Postoperative complications | Incidence of postoperative adverse reactions and complications, which are divided into five grades:
| Up to 30 days after operation |
| Motion of hip joints | Range of motion of hip joints during 3 days after operation. | Up to 72 hours after operation |
| Straight leg raising time | Time from the end of operation to the time that patient can raise his affected lower limb by himself (Unit: hour). | Up to 72 hours after operation |
| Ground exercise time | Time from the end of operation to the time that patient can do the ground exercise by himself (Unit: hour). | Up to 72 hours after operation |
| Mobilization time | Time frame from the end of operation to able to walk without external assistance (Walking aids such as crutches can be used, unit: hour). | Up to 72 hours after operation |
| Residual amount of drug | Residual amount of drug in the analgesic pump. | Up to 72 hours after operation |
| Postoperative analgesics requirement | Postoperative analgesics requirement during 3 days after operation | Up to 72 hours after operation |
| Total in-hospital cost. | Total hospitalization expenses after the destruction of costly consumables in orthopedic operation. | Up to 30 days after operation |
| Length of stay (LOS) in hospital | Time frame from the day of hospital admission to discharge from the hospital (unit: days) | Up to 30 days after operation |
| Postoperative LOS | Time frame from the day of operation to discharge from the hospital (unit: days). | Up to 30 days after operation |
| Re-admission rate | The incidence of re-admission within 30 days after surgery. | Up to 30 days after operation |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D000470 |
| Alkaloids |
| D006571 | Heterocyclic Compounds |
| D006572 | Heterocyclic Compounds, Bridged-Ring |
| D006576 | Heterocyclic Compounds, 4 or More Rings |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D010616 | Phenanthrenes |
| D011084 | Polycyclic Aromatic Hydrocarbons |
| D011083 | Polycyclic Compounds |
| D005283 | Fentanyl |
| D010880 | Piperidines |
| D006573 | Heterocyclic Compounds, 1-Ring |