Oxycodone Not superior to Paracetamol, Codeine combo for Pain relief After Fracture Surgery: JAMA
Prescribing opioids for chronic pain has increased despite evidence of the association of their long-term use with adverse outcomes. A recent study found that oxycodone (strong opioid) did not provide superior pain relief compared with combination acetaminophen and codeine (mild opioid) after the first 7 days of fracture surgery, despite a 6-fold higher dose of opioid being delivered in the strong opioid group. The study findings were published in the journal JAMA Network Open on November 17, 2021.
Patients with a surgically managed fracture are commonly discharged from the hospital with a strong opioid prescription, but limited evidence exists to support this practice. Therefore, researchers of the University of New South Wales, South Western Sydney Clinical School, Australia, conducted a study to evaluate whether strong opioids provide better analgesia than mild opioids over the first-week post-discharge from hospital after fracture surgical treatment.
It was a double-blind, superiority, randomized clinical trial conducted at a single-centre, major trauma hospital in Sydney, Australia. The researchers included a total of 120 patients with 1 or more acute orthopedic fractures requiring surgical fixation and were randomized to the strong-opioid group (n=59; oxycodone hydrochloride 5 mg of 10 mg) and mild opioid group (n=61; combination acetaminophen and codeine 500 mg and 8 mg or 1000 mg and 16 mg). The major outcome assessed was the mean of daily pain scores collected during week 1 of treatment measured using the Numerical Pain Rating Scale (NRS). Participants were asked to rate their mean pain over the previous 24 hours daily using an NRS score from 0 to 10, with 0 representing no pain and 10 representing the worst pain imaginable. The researchers further assessed the EuroQol 5-Dimension 5-Level Questionnaire (EQ-5D-5L) responses, worst pain, medication adverse events, global perceived effect, and return to work.
Key Findings of the study were:
- Upon analysis, the researchers found that the mean daily NRS pain score was 4.04 in the strong opioid group and 4.54 in the mild opioid group from day1 to 7 post-discharge.
- They noted that the between-group difference of the primary outcome was not statistically significant (−0.50) despite a 6-fold increased dose of opioids being delivered in the strong opioid group.
The authors concluded, "his study found that treatment with strong opioid medication subacutely was not superior to treatment with milder medication for the treatment of pain among patients with surgically managed orthopedic fractures. These findings suggest that ongoing first-line strong opioid use after discharge from the hospital should not be supported."
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