Xiaowei Xu,1,* Honggang Zhang,1,* Jun Li,2,* Li Zhou,1,3 Shengmei Zhu,1 Fangping Bao1 

1Department of Anesthesiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, 310003, People’s Republic of China; 2Department of Anesthesiology, Shulan (Hangzhou) Hospital, Shulan International Medical College, Zhejiang Shuren University, Hangzhou, Zhejiang Province, 310022, People’s Republic of China; 3Department of Pain Medicine, Ningbo No.6 Hospital, Ningbo, Zhejiang Province, 315040, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Fangping Bao Department of Anesthesiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Qingchun Road 79, Hangzhou, Zhejiang Province, 310003, People’s Republic of China, Tel +8613958105226, Email baofp@zju.edu.cn Shengmei Zhu, Department of Anesthesiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Qingchun Road 79, Hangzhou, Zhejiang Province, 310003, People’s Republic of China, Tel +8613857169801, Email smzhu20088@zju.edu.cn

Purpose: This study evaluated whether oxycodone alone could substitute for fentanyl combined with remifentanil for general anesthesia in laparoscopic uterine myoma surgery.
Patients and Methods: 90 adult female patients were randomized into three groups: oxycodone 0.35 mg/kg (Group A), oxycodone 0.30 mg/kg (Group B), or fentanyl 5 μg/kg (Group C) for induction. Anesthesia was maintained with propofol plus saline (Groups A/B) or remifentanil (Group C). Primary outcomes included Numerical Rating Scale (NRS) pain scores in the Post-Anesthesia Care Unit (PACU). Secondary outcomes were intubation reaction, vital signs, extubation/PACU times, Ramsey Sedation Scores (RSS) in PACU, NRS pain scores and adverse events within 48 hours postoperatively.
Results: Intubation reactions were rare (one case each in Groups B/C, none in Group A). Group B had significantly lower PACU NRS scores than Group C (0.6 ± 0.7 vs 1.3 ± 1.4, P = 0.011), while Group A showed a nonsignificant trend (0.8 ± 0.9 vs 1.3 ± 1.4, P = 0.051). RSS scores, extubation/PACU times, and 48-hour NRS scores were comparable. However, oxycodone groups had longer postoperative evacuation times than fentanyl group (Group A vs Group C: 20.0 ± 7.3 hours vs 16.5 ± 5.1 hours, P=0.038; Group B vs Group C: 20.3 ± 8.2 hours vs 16.5 ± 5.1 hours, P=0.034).
Conclusion: Oxycodone alone provides superior early postoperative analgesia compared to fentanyl-remifentanil in laparoscopic myoma surgery but may delay bowel recovery.

Keywords: oxycodone, laparoscopic surgery, myomas, fentanyl, postoperative pain