Different effects of oxycodone and remifentanil in patients undergoing ultrasound-guided percutaneous radiofrequency ablation of hepatic cancer: a randomized trial

Abstract

Background: Percutaneous radiofrequency ablation (RFA) is a recently introduced alternative technique for the treatment of hepatic cancer. Anesthesia is required for RFA of hepatic cancer to achieve patient comfort and immobilization during this painful procedure. The purpose of this study was to investigate the analgesic efficacy and evaluate the safety of a single intravenous injection of oxycodone hydrochloride for this procedure.

Patients and methods: A total of 120 American Society of Anesthesiologists class I-II grade patients for elective ultrasound-guided percutaneous RFA were enrolled in this randomized controlled trial. Patients were randomized (1:1) to receive either a single intravenous injection of oxycodone (group O) or continuous infusion of remifentanil (group R). Both groups received the continuous infusion of dexmedetomidine for sedation. Visual analog scale (VAS), rescue analgesic, and side effects were checked during the periprocedural period. In addition, patient and oncologist satisfaction on a scale of 1-5 were determined.

Results: VAS score in group O was significantly lower than in group R at 1, 2, and 3 hours after RFA, and patients in group O required analgesics significantly later and less doses in the first 24 hours after RFA. The occurrence of unwanted body movements was significantly lower in group O. We found no complications including allergic reaction, excessive sedation, and chest wall rigidity in all patients. The patient satisfaction score was significantly higher in group O than that in group R.

Conclusion: Ultrasound-guided percutaneous RFA for hepatic cancer can be completed both with continuous infusion of remifentanil or a single intravenous injection of oxycodone. However, oxycodone hydrochloride provides better patient experience with higher satisfactory score and less unwanted body movements, relieves post-procedural pain better, and is not associated with an increase in adverse effects.

Keywords: analgesia; hepatic cancer; oxycodone; radiofrequency ablation.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1

Changes in Ramsay sedation scale and vital signs during periprocedural period. Notes: Data are expressed as the mean ± SD. *P<0.05 and **P<0.01 when compared between groups, two-sample Student’s t-test. Group O = oxycodone group. Group R = remifentanil group. Abbreviations: O, oxycodone; PACU, post-anesthesia care unit; R, remifentanil; RFA, radiofrequency ablation.

Figure 2

VAS at the indicated time points during the 6-hour period following RFA for both groups. Notes: Data are expressed as the mean ± SD. *P<0.05 and **P<0.01 when compared between groups, two-sample Mann–Whitney U rank-sum test. Group O = oxycodone group. Group R = remifentanil group. Abbreviations: O, oxycodone; R, remifentanil; RFA, radiofrequency ablation; VAS, Visual analog scale.

Figure 3

Differences in patient and oncologist satisfaction on a scale of 1–5 (1= not at all satisfied, 2= dissatisfied, 3= okay, 4= satisfied, 5= very satisfied). Notes: Data are expressed as the mean ± SD. *P<0.05, two-sample Mann–Whitney U rank-sum test. Group O = oxycodone group. Group R = remifentanil group. Abbreviations: O, oxycodone; R, remifentanil.