Sequential method for the determination of 50% effective dose of oxycodone for subcutaneous injection in preoperative analgesia in patients with Stanford type A aortic dissection

doi:10.12092/j.issn.1009-2501.2019.08.011

Abstract

Abstract:

AIM: To determine the half effective dose (ED50) of oxycodone subcutaneously for preoperative analgesia in patients with Stanford type A aortic dissection using sequential method. METHODS: Thirty patients with Stanford type A aortic dissection were enrolled. The American Society of Anesthesiologists (ASA) grades II to III were scheduled for emergency surgery under general anesthesia. According to the sequential method of increasing or decreasing administration, the first patient was injected subcutaneously with oxycodone 5.0 mg 60 minutes before anesthesia, and the adjacent dose gradient was 0.5 mg. If the previous patient had satisfactory analgesic effect, the next patient dose was reduced by 0.5 mg. If the last patient's analgesic effect is not satisfactory, the next patient dose is increased by 0.5 mg. After sequential administration, visual analgesia (VAS) was used to evaluate the analgesic effect. VAS≤3 was effective in analgesia. The ED50 and 95% confidence intervals for preoperative analgesia in patients with Stanford type A aortic dissection were calculated using the Dixon and Massey sequential distribution test formula. RESULTS:The overall satisfaction of patients in satisfactory analgesic effect group was higher than that of patients in unsatisfactory analgesic effect group (P<0.05), but there was no significant difference between in the rate of remedy analgesia the two groups (P>0.05). The ED50 of subcutaneous oxycodone for preoperative analgesia in patients with Stanford type A aortic dissection was 2.9 mg with a 95% confidence interval of 2.3 to 3.4 mg. CONCLUSION:The ED50 of subcutaneous oxycodone for sequential analgesia in patients with Stanford type A aortic dissection was 2.9 mg, and the method was simple, efficient and accurate.

Key words: oxycodone, subcutaneous injection, aortic dissection, preoperative medication, sequential method, half effective dose

CLC Number:

R614
R441.1

ZHOU Junhui, MENG Xianhui. Sequential method for the determination of 50% effective dose of oxycodone for subcutaneous injection in preoperative analgesia in patients with Stanford type A aortic dissection[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2019, 24(8): 916-921.

References

［1］Nienaber CA, Clough RE.Management of acute aortic dissection［J］.Lancet,2015, 385(9970):800-811.
［2］中国心胸血管麻醉学会心血管麻醉分会.Stanford A型主动脉夹层外科手术麻醉中国专家临床路径管理共识［J］.临床麻醉学杂志,2018,34(10):1009-1013.
［3］Pergolizzi JV Jr, Seow-Choen F, Wexner SD, et al. Perspectives on intravenous oxycodone for control of postoperative pain ［J］. Pain Pract, 2016, 16(7):924-934.
［4］唐作垒,吴畏.盐酸羟考酮预防麻醉诱导中芬太尼诱发患者咳嗽的效果［J］.中华麻醉学杂志,2014,34(6):668-669.
［5］Roelants F, Lavand'homme P. Clonidine versus oxycodone as an adjuvant to ropivacaine in patient-controlled epidural labour analgesia: A randomised double-blind trial ［J］. Eur J Anaesthesiol, 2015, 32(11):805-811.
［6］Kokki M, Broms S, Eskelinen M, et al. The analgesic concentration of oxycodone with co-administration of paracetamol-- a dose-finding study in adult patients undergoing laparoscopic cholecystectomy ［J］. Basic Clin Pharmacol Toxicol, 2012, 111(6):391-395.
［7］Miller J, Dunion A, Dunn N, et al.Effect of a brief massage on pain, anxiety, and satisfaction with pain management in postoperative orthopaedic patients ［J］. Orthop Nurs, 2015, 34(4):227-234.
［8］Zhang YF, Xiao F, Xu WP, et al.Prophylactic infusion of phenylephrine increases the median effective dose of intrathecal hyperbaric bupivacaine in cesarean section: A prospective randomized study ［J］. Medicine (Baltimore), 2018, 97(32): e11833.
［9］中国医师协会心血管外科分会大血管外科专业委员会.主动脉夹层诊断与治疗规范中国专家共识［J］.中华胸心血管外科杂志,2017,33(11):641-654.
［10］刘曌宇,柴博兰,邹远林,等.482例主动脉夹层患者死亡因素的Logistic回归分析［J］.华中科技大学学报（医学版）,2014,(6):697-700.
［11］Bortolato A, Ori C, Freo U.Thoracic epidural analgesia for type B aortic dissection ［J］. J Anaesthesiol Clin Pharmacol, 2017, 33(2):260-261.
［12］钱祖超,张群,罗华梁,等.盐酸羟考酮用于腹腔镜直肠癌根治术患者镇痛效果的观察［J］.中国临床药理学与治疗学,2015,20(5):587-590.
［13］王俊,蒋宗明,郑君刚,等.右美托咪定复合盐酸羟考酮术后镇痛对胃肠肿瘤病人睡眠质量的影响［J］.中国临床药理学与治疗学,2018,23(2):165-169.
［14］徐建国.盐酸羟考酮的药理学和临床应用［J］.临床麻醉学杂志,2014,30(5):511-513.
［15］Takahashi Y, Iseki M. Sustained-release opioids: morphine, oxycodone and tapentadol ［J］. Masui, 2015, 64(11):1133-1140.
［16］Brust A, Croker DE, Colless B, et al. Conopeptide-derived κ-opioid agonists (conorphins): potent, selective, and metabolic stable dynorphin a mimetics with antinociceptive properties ［J］. J Med Chem, 2016, 59(6):2381-2395.
［17］项小兵,方军,金孝岠,等.布比卡因腰麻剖宫产术中舒芬太尼的半数有效剂量［J］.中国临床药理学与治疗学,2014,19(6):663-665.
［18］Ono AH, Moura TR, Govêia CS, et al. ED50 of remifentanil for providing excellent intubating conditions when co-administered with a single standard dose of propofol without the use of muscle relaxants in children: dose-finding clinical trial ［J］. J Anesth, 2018, 32(4):493-498.
［19］李妮娟,吴畏.关腹前应用盐酸羟考酮对全身麻醉下妇科腹腔镜手术患者血流动力学及镇静作用的影响［J］.中国药房,2017,28(5):667-669,670.

[1]	ZHU Bingqing, HAN Mingming, ZHAI Mingyu, YANG Jia, LI Juan. Effects of oxycodone hydrochloride on anesthesia recovery quality in surgical revascularization for moyamoya disease [J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2019, 24(8): 928-932.
[2]	LI Jiajia, SHENG Yi, HUANG Mengmeng, HAN Yuan, ZHU Chunchun, LIU Huacheng, LI Jun. Comparison of responses induced by tracheal extubation between different doses of oxycodone after thyroidectomy [J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2019, 24(11): 1287-1292.
[3]	XU Lili, WANG Yunfu, QUAN Bianrui. Effects of oxycodone hydrochloride controlled release tablets plus NB-UVB in the treatment of herpes zoster neuralgia [J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2018, 23(3): 333-336.
[4]	WANG Jun, JIANG Zongming, ZHENG Jungang, CAO Gang, HUANG Changshun, LU Zihui, JI Yiqin. Effects of oxycodone hydrochloride combined with dexmedetomidine postoperative analgesia on sleep quality of patients with gastrointestinal tumors [J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2018, 23(2): 165-169.
[5]	QIAN Zu-chao, ZHANG Qun, LUO Hua-liang. Efficacy of hydrochloride oxycodone analgesia on colorectal cancer eradication surgery patients under patient controlled analgesia [J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2015, 20(5): 587-590.
[6]	CHI Chuang, HE Zhi-feng, LIU Yu, SUN Cheng-chao. Recombinant coagulation factor Ⅶa for the treatment of intraoperative bleedings in Stanford type A aortic dissection [J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2013, 18(5): 524-526.
[7]	CHENG Zi-an. Efficacy comparison on insulin with subcutaneous therapy four times a day and twice a day in newly diagnosed type 2 diabetes patients [J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2011, 16(11): 1297-1299.
[8]	WANG Rui, PEI Fei, CHAI Dong, FANG Yi, ZHENG Zhuan-jie, SHANG Wen, LIANG Bei-bei, DONG Tao, LI Cong-ran, AN Mao-mao. Study on tolerance of subcutaneous injection in single dose of recombinated human glucagon-like peptide-1 in Chinese healthy volunteers [J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2007, 12(7): 814-818.
[9]	ZHANG Zhi-yong, JIA Nai-guang, HUANG Wen-qi, HUANG Yu-guang, LIU Wei, GAO Xue-song, YANG Yang, Zhang Ya-jun, LIU Chun-xia, Cao Lei, LIN Shi-qing. Safety and efficacy of early oral oxycodone/acetaminophen and tramadol in Chinese gynecology patients undergoing laparoscopy operation [J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2005, 10(2): 168-171.