• 대한치과마취과학회지
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• 제13권4호
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• pp.167-178
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• 2013

Oxycodone is a semi-synthetic opioid synthesized from poppy-derived thebaine. It is a narcotic analgesic generally indicated for relief of moderate to severe pain. Although developed in an attempt to improve on the existing opioids, the adverse effects of oxycodone are those that are typically found in opioids. In recent years, the use of the opioid oxycodone has increased markedly and replacing morphine as the first line choice of opioid in several countries. There are formulations for oral immediate, oral extended release and intravenous use. In 2013, intravenous oxycodone was approved for marketing by Ministry of Food and Drug Safety (MFDS), with the indication of postoperative intravenous patient-controlled analgesia (IV PAC). Simulation study of oxycodone demonstrated that minimum effective analgesic concentration (MEAC) of oxycodone was most quickly reached with higher loading dose and IV PCA with background infusion, which may reduce the necessity of rescue analgesics during immediate postoperative period. Previous studies for postoperative pain management with intravenous oxycodone are limited in sample size, mostly less than 100 patients, which may not be large enough to assess safety of intravenous oxycodone. The effectiveness and tolerability of IV PCA with oxycodone should, therefore, be evaluated in large scale clinical trials in Korean populations.

• Journal of Hospice and Palliative Care
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• 제26권1호
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• pp.18-21
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• 2023

The combination of oxycodone and naloxone is useful for cancer pain management. Naloxone, as a pure opioid antagonist, cannot be used simultaneously with opioids. However, owing to its low bioavailability, it can be used in an oral composite formulation. We present the case of a 55-year-old man with gastric cancer who experienced severe opioid withdrawal syndrome (OWS) triggered by oxycodone/naloxone that was successfully managed with dexmedetomidine. He had been in a stable condition on intravenous morphine to alleviate cancer pain. Intravenous morphine was switched to oral oxycodone/naloxone for discharge from the hospital. The patient suddenly developed restlessness, heartburn, and violent behavior 30 minutes after taking oxycodone/naloxone. We attempted sedation with midazolam and propofol, but paradoxical agitation and desaturation occurred. Next, we tried dexmedetomidine and the patient showed a decreased heart rate and reduced agitation. The patient was eventually stabilized by increasing the dose of dexmedetomidine. This report informs clinicians of the possibility of OWS when switching from opioids to oxycodone/naloxone, which can be overcome with the appropriate use of sedatives and dexmedetomidine depending on the patient's condition.

• Journal of Hospice and Palliative Care
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• 제20권2호
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• pp.131-135
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• 2017

목적: 경구 oxycodone/naloxone 복합제는 아편유사제에 의해 유발되는 변비를 완화시키거나 예방하는 목적으로 사용되고 있다. Naloxone에 의해 oxycodone의 진통 효과가 상쇄되거나 금단증상이 나타난다는 보고는 거의 없었으나 저자는 실제 임상에서 몇몇 금단증상 예를 경험하였기에 이 환자들에 대한 조사 연구를 수행하였다. 방법: 2012년 1월 1일부터 2016년 12월 31일까지 경남 지역 암센터에 방문했던 진행성 암환자들로 oxycodone/naloxone extended-release tablets를 투약 받고 마약 금단증상이 나타났던 환자들의 의무기록을 후향적으로 조사하였다. 결과: 연구 기간 중 경구 oxycodone/naloxone을 처방 받은 1,641명의 암 환자 중, 총 10예(0.6%) 에서 마약 금단 증상을 겪었다. 금단증상 관련 통증 강도의 변화는 oxycodone/naloxone 투여 전 NRS 3에서 평균 NRS 6점으로 증가하였다. 금단증상 중 오한이 10예 중 7예에서 나타나 가장 많이 나타난 증상이었으며 그 외에 식은땀, 전신 쇠약감, 근육경련, 복부경련(각 5예), 불안(4예), 열, 어지럼증, 의식혼란, 하품(각 2예)의 순으로 빈번하게 관찰되었다. 결론: Oxycodone/naloxone extended-release 복합제에 의한 마약 금단증상은 흔하지는 않아도 적은 수의 환자에서라도 나타날 수 있다. 향후 이에 대한 다기관, 전향적 연구가 필요하다.

• Asian Pacific Journal of Cancer Prevention
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• 제15권20호
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• pp.8797-8800
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• 2014

Objective: To analyze cost-effectiveness of morphine, MS contin and oxycodone in the treatment of cancer pain, providing guidance for rational drug use in the clinic. Methods: Confirmed by histology, a total of 171 patients with various cancers who required analgesic treatment were selected and divided into 3 groups, 57 cases for each group, given morphine, MS contin and oxycodone, respectively. If there appeared a poor short-term effect or aggravated sudden pain during the treatment, a short-acting morphine injection was given and adverse reactions were processed by symptomatic treatment. The pain relief rate and adverse reactions of groups were observed and pharmacoeconomics evaluation was undertaken. Results: The pain relief rates with morphine, MS contin and oxycodone were 89.5%(51/57), 91.2%(52/57) and 93.0%(53/57), respectively, with no difference samong groups (${\chi}^2=4.4489$, P=0.6162). The occurrence rates of adverse reactions were 59.7%(34/57), 54.4%(31/57) and 43.9%(25/57), again with no significant variation (P>0.05). The ratios of cost-effectiveness (C/E) for the 3 groups were $14.6{\pm}7.21$, $15.0{\pm}7.44$ and $16.1{\pm}8.10$. When the price of 3 kinds of analgesics was reduced by 10%, the ratios of cost-effectiveness were $12.2{\pm}6.53$, ($13.4{\pm}6.08$ and $14.5{\pm}6.74$ but there was no differences when compared with before the price adjustment (t=1.86, P=0.0651; t=1.30, P=0.1948; t=1.17, P=0.2453). Conclusion: Morphine, MS contin and oxycodone give similar pain relief and adverse reaction rates but of all, morphine is the preferred drug for the treatment of cancer pain from the perspective of pharmacoeconomics.

• Asian Pacific Journal of Cancer Prevention
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• 제15권23호
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• pp.10445-10449
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• 2015

Objective: To observe treatment effects and safety of fluvoxamine combined with oxycodone prolonged-release tablets in treating patients with moderate to severe cancer pain. Methods: Patients confirmed pathologically with cancer and complicated with moderate to severe pain, were divided into control and experimental groups. Oxycodone prolonged-release tablets, with or without fluvoxamine, were administrated to all study patients until pain relief. Degree of pain relief, dose of oxycodone prolonged-release tablets, side effects and quality of life were compared before and after treatment. Results: In total, 120 patients were recruited. No statistically significant difference was detected regarding age, gender, types of cancer, KPS between two groups of patients (P>0.05). Baseline pain score of patients with moderate pain in treatment and control group was $4.9{\pm}0.8$ and $5.1{\pm}0.8$, respectively; and decreased to $1.8{\pm}1.1$ and $1.2{\pm}1.1$ after treatment, respectively. Pain intensity was significantly reduced in the treatment group (P=0.028). Average daily consumption of oxycodone prolonged-release tablets was ($54.0{\pm}19.6$) mg and ($44.7{\pm}18.7$) mg respectively, which is lower in treatment grpup than in control group, but the difference was not statistically significant (P=0.065). Baseline pain score of patients with severe pain in treatment and control groups were $8.3{\pm}1.1$ and $8.3{\pm}1.1$, respectively; and pain intensity after treatment decreased to $2.9{\pm}1.0$ and $2.3{\pm}1.0$. Pain intensity was significantly reduced in the treatment group, with statistical significance (P=0.026). Average daily consumption of oxycodone prolonged-release tablets was ($132.0{\pm}42.2$) mg and ($110.7{\pm}33.9$) mg, respectively, which is lower in treatment group than in control group, and the difference was statistically significant (P=0.035). In terms of quality of life, patients in treatment group had better performance status, daily activity, mood, and sleep than that in control group (P < 0.05). Patients in two groups had similar side effects, eg., constipation, nausea/vomiting, lethargy, dizziness, itchy skin, dysuria, and ataxia. Lower incidence of nausea/vomiting, lethargy, was obtained from patients in treatment than in control group, while significant low constipation was observed in treatment than in control group (35.0% vs 49.2%, P=0.026). Conclusion: Fluvoxamine combined with oxycodone prolonged-release tablets could be more effective in treating patients with cancer pain, and could reduce the dosage of oxycodone prolonged-release tablets and thus be associated with lower side effects, and improved quality of life.

• 한국임상약학회지
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• 제21권1호
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• pp.30-35
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• 2011

The objective of this study was to find out drug use pattern of narcotic analgesics in university hospitals in Korea. A university hospital located in Kyungbuk province was chosen for this study. The drug use pattern was analyzed in terms of ingredient, administration route, patient type, and attending department. Amount of drug usage was counted by unit dose defined by the number of ampule or vial for injectable, tablet or capsule for oral, and each for patch preparations. Result showed that 11 narcotic analgesic ingredients were used during 2007-2009, and the drug usage was increased by about 20% annually during the period. Proportion of oral preparations used for pain management was about two third of all narcotic analgesics usage and kept increasing during the period. Proportion of the drug usage for outpatients was also steadily increased. Notably, the usage of oral preparations of oxycodone, morphine, and hydromorphone was rapidly increased for the management of cancer pain while the usage of codeine and codeine-containing composite preparations for cancer pain were minimal (<10%). About 90% of all narcotic analgesics were used by physicians in Internal Department, especially in Oncology Division of the Department. These findings suggest that pain management is becoming more aggressive and in agreement with WHO's guidelines regarding selection of administration route. However, in terms of 3-step ladder for cancer pain management, the drug use pattern was not congruent to WHO's guidelines. Therefore, in conclusion, it appears that physicians need to try to be congruent to the guidelines when using narcotic analgesics for cancer pain.

• Clinics in Shoulder and Elbow
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• 제18권4호
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• pp.237-241
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• 2015

Background: We investigated the effectiveness of pain management and the adverse events of intravenous (IV) patient-controlled analgesia (PCA) after orthopedic surgery. Methods: From September 2014 and August 2015, we performed a retrospective analysis of 77 patients who underwent orthopedic surgery of the shoulder or the elbow in our hospital. The composition of the intravenous PCA administered to the patients was as follows: 250 mg of dexketoprofen trametamol, 70 mg of oxycodone, and 0.6 mg of ramosetron, which were made up to 79 ml of normal saline. We evaluated and statistically analyzed the difference in the visual analogue scale (VAS) scores for pain at immediate postoperation, at 24 hours of PCA, at 72 hours of PCA, and after discontinuation of PCA and in the incidence of adverse events. Results: We found that VAS score decreased for 3 postoperative days and that with discontinuation of IV PCA a meaningful change in VAS score was no longer seen. Of the 77 patients, 22 presented with adverse events (28.6%). We terminated IV PCA temporarily in the 21 patients who presented with adverse events; we terminated analgesia permanently in one patient (1.2%). Consequently, 76 of 77 patients carried out IV PCA till the designated period. Conclusions: Intravenous PCA after orthopedic surgery of the shoulder or the elbow may be accompanied with adverse events. Careful assessment of the patient and treatment of the adverse outcomes are key to a successful maintenance of PCA and to a successful management of postoperative pain.

• The Korean Journal of Pain
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• 제31권3호
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• pp.191-198
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• 2018

Background: Patient-controlled epidural analgesia (PCEA) is known to provide good postoperative analgesia in many types of surgery including laparoscopic surgery. However, no study has compared PCEA with patient-controlled intravascular analgesia (PCIA) in laparoscopic radical prostatectomy (LARP). In this study, the efficacy and side effects of PCEA and PCIA after LARP were compared. Methods: Forty patients undergoing LARP were randomly divided into two groups: 1) a PCEA group, treated with 0.2% ropivacaine 3 ml and 0.1 mg morphine in the bolus; and 2) a PCIA group, treated with oxycodone 1 mg and nefopam 1 mg in the bolus. After the operation, a blinded observer assessed estimated blood loss (EBL), added a dose of rocuronium, performed transfusion, and added analgesics. The numeric rating scale (NRS), infused PCA dose, and side effects were assessed at 1, 6, 24, and 48 h. Results: EBL, added rocuronium, and added analgesics in the PCEA group were less than those in the PCIA group. There were no significant differences in side-effects after the operation between the two groups. Patients were more satisfied with PCEA than with PCIA. The NRS and accumulated PCA count were lower in PCEA group. Conclusions: Combined thoracic epidural anesthesia could induce less blood loss during operations. PCEA showed better postoperative analgesia and greater patient satisfaction than PCIA. Thus, PCEA may be a more useful analgesic method than PICA after LARP.

• 디지털융복합연구
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• 제20권5호
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• pp.681-693
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• 2022

본 연구는 근골격계 질환으로 입원한 환자의 의무기록지 키워드 네트워크 분석을 통해 근골격계와 관련된 표준의료용어를 유추하여 보건의료현장의 비정형화된 데이터 활용 방안을 제시하기 위함이다. 분석 대상은 2010년부터 2019년까지 근골격계 질환 환자의 입퇴원요약지 145부로, 더아이엠씨(The IMC)에서 개발한 빅데이터 분석 솔루션인 TEXTOM을 활용하여 분석하였다. 1차·2차 정제과정을 통해 도출된 177개의 근골격계 관련 용어를 최종 분석하였다. 연구결과 다빈도 용어는 'Metastasis', 의료용어 체계별 분석 결과에서 임상소견은 'Metastasis', 증상은 'Weakness', 진단은 'Hepatitis', 처치는 'Remove', 신체구조는 'Spine', 약물은 'Oxycodone'이 가장 많이 사용되었다. 이러한 결과를 바탕으로 정형화되지 않은 의료데이터의 분석과 활용 및 관리 방안에 대한 시사점을 제안하고자 한다.

• Archives of Plastic Surgery
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• 제51권2호
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• pp.156-162
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• 2024

Background Perioperative management in autologous breast reconstruction has gained focus in recent years. This study compares two pain management protocols in patients undergoing abdominal-based free flap breast reconstruction: a past protocol (PP) and a current protocol (CP)-both intended to reduce opioid consumption postoperatively. The PP entails use of a pain catheter in the abdominal wound and the CP consists of an intraoperative nerve block in addition to refinements in the oral pain management. We hypothesize that the CP reduces opioid consumption compared to PP. Methods From December 2017 to January 2020, 102 patients underwent breast reconstruction with an abdominal-based free flap. Two postoperative pain management strategies were used during the period; from December 2017 to September 2018, the PP was used which entailed the use of a pain catheter with ropivacaine applied in the abdominal wound with continuous distribution postoperatively in addition to paracetamol orally and oxycodone orally pro re nata (PRN). From October 2018 to January 2020, the CP was used. This protocol included a combination of intraoperative subfascial nerve block and a postoperative oral pain management regime that consisted of paracetamol, celecoxib, and gabapentin as well as oxycodone PRN. Results The CP group (n = 63) had lower opioid consumption compared to the PP group (n = 39) when examining all aspects of opioid consumption, including daily opioid usage in morphine milligram equivalents and total opioid usage during the stay (p < 0.001). The CP group had shorter length of hospital stay (LOS). Conclusion Introduction of the CP reduced opioid use and LOS was shorter.