DOI: 10.1093/bja/aeh218 Epidural oxycodone or morphine following gynaecological surgery{

Background. The analgesic action of oxycodone is of rapid onset, in contrast to morphine, and is mediated by kappa-opioid receptors of the spinal cord. We compared analgesia and side-effects of epidural oxycodone with those of morphine after gynaecological surgery. Methods. We studied prospectively in 75 women in a double-blind, randomized manner: epidural morphine6mgday1 (n=25), epiduraloxycodone6mgday1 (n=25) andepiduraloxycodone12mg day1 (n=25). All patients underwent gynaecological surgery under general (isoflurane and nitrous oxide) and epidural anaesthesia. Visual analogue scale (VAS) pain scores at rest and on coughing, verbal descriptive scale (VDS) satisfaction scores, sedation scores, pruritus scores and nausea/ vomiting scores were recorded for 3 days after surgery. Results. VAS pain scores at rest in patients who received oxycodone 6 mg day1 were higher than in patients who received morphine 6 mg day1 at 6 h and on the first postoperative day and were significantly higher than in patients who received oxycodone 12 mg day1 on the first postoperative day. Scores for nausea, vomiting and pruritus in patients who received oxycodone 6 mg day1 and 12 mg day1 were lower than those in patients who received morphine. No significant differences were seen in VAS at cough and VDS satisfaction scores between the three groups. Conclusion. Epidural oxycodone was as effective as morphine at the doses investigated, with fewer side-effects