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COMPARATIVE TIME ACHIEVED VAS 3 ON OXYCODONE DOSAGE 1 MG / HOUR AND

FENTANIL DOSAGE 0.5 MCG / KGBW / HOURS CONTINUE INTRAVENA IN


OVERCOMING THE POST SURGICAL LONG BONE WITH A GENERAL ANESTHESY IN
RSUP HAJI ADAM MALIK MEDAN

Virat Kumar, Achsanuddin Hanafie, Hasanul Arifin, Akhyar H. Nasution

Anesthesiology and Intensive Therapy Faculty of Medicine of North Sumatra

Background: As the number and type of surgery that is done everyday at this time, the acute pain management is an
important aspect of perioperative anesthesia care. In the United States who undergo surgery, there are approximately 80% of
patients experiencing acute postoperative pain, and nearly 25% of patients receiving pain treatment experience disturbing
side effects. Opioids are the most popular drug used in the first 24 hours postoperative during fasting, but some patients
reject the method of opioid administration. Fentanyl with the analogues of sufentanil and alfentanil are the most widely used
opioids today. Fentanyl has a potency ratio 100 times stronger than morphine. Oxycodone is a receptor agonist of mu- and
kappa-opioid, structurally similar to codeine, but pharmacodynamically similar to morphine.
objective: To find out the comparison of time achievement of VAS 3 on oxycodone dose 1 mg / hourand fentanyl dose
0.5 mcg / kgbw / hour intravenous continuous in overcoming post-operative pain of long bone with general anesthesia
Methods: This study was conducted using a double-blind randomized clinical trials after approval from the Ethics
Committee of the Faculty of Medicine, Faculty of Medicine, University of North Sumatra, collected 48 samples of the study,
ages 21-60 years, PS ASA I-II, which will be long elective orthopedic surgery with using general anesthesia
techniques. Once calculated statistically, all samples were randomly divided into 2 groups. Group A
received Oxycodone with 5 mg initial bolus followed by a continuous infusion dose of 1 mg / hour and Fentanyl with the
initial bolus 5 cc of NaCl 0.9% followed by a continuous infusion dose of 0.5 mcg / hour. The drug is given when the patient
has completed extubation. The result data were tested by Mann Whitney, Chi-Square, with significance level 95% (p <0,05).
Results: Average time to reach VAS 3 group given the drug Fentanyl is 2.58 0.50 hours longer than the average time to
reach the 3 groups were given VAS Oxycodone drug was 1.46 0.51 hours. Based on the statistical test by Mann-Whitney
test showed no difference in time to reach the third VAS between the two groups of research subjects (p <0.05).The results
showed that the average length of surgery kelompo k given medication Fentanyl is 218.96 53.38 minutes a little bit longer
than the average length of surgery group given the drug Oxycodone is 191.87 80.10 download it (p> 0.05).
Conclusion: Oxycodone is faster in achieving VAS3 compared with Fentanyl intravenous intravenous infusion after long
bone surgery at RSUP Haji Adam Malik Medan.

Keywords: Oxycodone, Fentanyl, Opiates, Visual Analogue Score, Effectiveness

Introduction administration and becomes resistant to


Fentanyl has a potential ratio 100 times commonly used opioid doses. (Fabregat, 2011)
stronger than morphine. (Barash, 2013) The Kloub in 2015 research the efficacy of
South African Society of Anesthesiologists Oxycodone for short-term pain management in
guidance on a continuous average dose of patients postoperative. The result was 263
fentanyl for postoperative pain was 1-5 mcg / kg patients studied with a variety of surgical
/ Day. (SASA, 2009) procedures. It was reported that 220 (83,7%) of
Opioid drug most popular used in the patients had no pain and 20 (7.6%) of patients
first 24 hours postoperative during the patient's . reported pain with a score five of more than so it
It has been addicted by previous opioid was concluded. Oxycodone was effective in
treatment short-term pain in most types of fentanyl dose of 0.5 mcg / kgbw / hr intravenous
surgery. (Kloub, 2015) hour in overcoming post-operative pain pain
Park in 2015 studied 74 patients with general anesthesia. This research was
undergoing elective laparoscopic hysterectomy conducted at H. Adam Malik Hospital. Research
or laparoscopic myomectomy with random was conducted after the ethical clearance was
selected to published until the number of samples was met.
The study population was all elective
obtain fentanyl or Oxycodone using IV-
scheduled patients underwent long bone surgery
PCA (potential ratio 1:60). Patients were also
under general anesthesia techniques using ETT.
examined for postoperative pain, side effects,
The study sample fulfilled inclusion and criteria
and patient satisfaction, there was a significant
exclusion. Once calculated statistically, all
difference in the observation of patient
samples are divided into:
satisfaction with analgesics during the
a. Group A received oxycodone bolus 5 cc and
postoperative period. Patients in the Oxycodone
continued with an intravenous continuous 1
group showed lower intake of opioids (10.1
cc / hour continuous maintenance dose.
8.5 ml vs. 16.6 12.0 ml, P = 0.013) It was
b. Group B received fentanyl doses of 0.5 mcg /
found that Oxycodone and fentanyl showed an
kgbw continuous intravenously.
effect the same, (Park, 2015) Inclusion Criteria: Age 21-60 years,
the author wish to assess the difference patient undergoing long bone surgery,
in VAS value and adverse events after the physical status of ASA 1 and 2, with ideal body
administration of Oxycodone dose 1 mg / hour
weight according to BMI, the patient agreed to
and fentanyl dose of 0.5 mcg / kgbw / hour
intravenous continuous overcome post-surgical participate in the study. Exclusion Criteria:
pain of long bone surgery under general Patient who received opioid analgesic prior to
anesthesia on the grounds of finding alternative
surgery. Criteria of Disconnect Test (Drop
to opioid analgesic drugs which has the same
effect for postoperative pain management with Out): Occurred emergency heart and lung,
general anesthesia technique without side effect allergic reactions occur after the use of drugs
that can harm patient.
studied.
Methods Patient get an explanation about the
procedure to be followed and states informed
The design of this study used a double
consent. Both groups of patients were given
blinded controlled randomized clinical trial. To
preloading fluid Ringer Lactate 10 ml / kgBW.
determine differences in VAS value and adverse
Both groups were prepared for general
event after oxycodone dose 1 mg / hour and
anesthesia. Premedication with fentanyl 2 reached. The fentanyl drug will be increased by
mcg / kg, midazolam 0.05 mg / kg, awaited 0.5 mcg to VAS <3.
The patient was then observed in the
onset 5 minutes. Patients were induced with
recovery room and transferred to the care
propofol 2 mg / kg, rocuronium muscle
setting when the Aldrette Score was 10. The
paralytic 1 mg / kg, after onset of 1 min, direct
VAS assessment and side effects of the drug
laryngoscopy was performed with
were performed directly by the researchers at 0
laryngoscope and trachea was intubated with
(T0), 1 (T1), 2 (T2), 3 (T3), 4 (T4), 6 (T5), 12
appropriate size endotracheal tubes. Surgery
(T6) and 24 (T7) after surgery ends. T0 begins
begins, the maintenance of sedation using
after the patient is extubated and fully awake.
Isoflurane, maintenance of analgesia with
The results of observational data in both groups
fentanyl according to hemodynamic response,
were statistically comparable.
and maintenance of muscle paralysis using
rocuronium. Result
After surgery, after the patient fulfilled
the extubation criteria, the patient was Distribution of Research Subjects by Age,
Gender, Asa
extubated and the time was recorded as T0, and
Obat yang diberikan
VAS was assessed using the VAS drawing Karakteristik Morphin
e
Oxycodone
Total Nilai p*

1. Usia (tahun)
table, asked to the patient by showing the scale 19 29
11
(45,8%)
7 (29,2%)
18
(37,5%)
5
3 (12,5%) 2 (8,3%)
corresponding to the perception of pain felt by 30 39
(10,4%)
10
0,604
40 49 4 (16,7%) 6 (25,0%)
(20,8%)
the patient. This assessment is done directly by 50 - 59 6 (25%) 9 (37,5%)
15
(31,3%)
24 48
researchers who are not involved in the Total
(100%)
24 (100%)
(100%)
2. Jenis Kelamin
13 28
administration of drugs in these patients. The Laki - laki
(54,2%)
15 (62,5%)
(58,3%)
0,558
11 20
Perempuan 9 (37,5%)
(45,8%) (41,7%)
start time of the study in which group A Total
24
24 (100%)
48
(100%) (100%)

received oxycodonebolus 5 mg followed by 3. ASA


ASA 1
10
8 (33,3%)
19
(41,7%) (39,6%)
0,551
maintenance 1 mg / hour intravenous for 24 ASA 2
14
(58,3%)
16 (66,7%)
29
(60,4%)
24 48
Total 24 (100%)
hours, whereas group B received fentanyl with *Fisher exact test.
(100%) (100%)

initial bolus using 0.9% 0.5 cmcococcus 0.5


mg / kgbb / hour intravenous hour for 24 hours.
Statistically did not show any significant
If during the course of the study the patient is differences in age, sex and ASA between the
still painful (VAS> 3) then oxycodonean drug two study groups (p> 0.05).
is increased 1 mg per hour until VAS <3 is
Distribution of Research Subjects based on Obat yang Mea
Std.
Deviati
Media Minimu Maximu Nila
diberikan n n m m i p*
preoperative VAS values on

2
Fentanyl 2,58 0,50 3 2 3
4
0,00
Obat 1
2
VAS Pre Op Total Nilai p* Oxycodone 1,46 0,509 1 1 2
4
Fentanyl Oxycodone

*Mann-Whitney test
4 15 (62,5%) 11 (45,8%) 26 (54,2%)

0,247 Based on statistical tests with Mann-


5 9 (37,5%) 13 (54,2%) 22 (45,8%)
Whitney test showed no time difference to
Total 24 (100,0%) 24 (100,0%) 48 (100,0%) achieve VAS 3 between the two study subjects
*Chi-Square Tests (p <0.05).
Statistically, there was no significant
difference in preoperative VAS between the two Average VAS Score of Oxycodone and Fentanyl
study groups (p> 0.05). T0-T7 Groups
The average difference in the duration
of surgery based on the given drug
Lama Operasi (Menit)
Nil
Obat yang
n Std. ai
diberikan Mea Medi Minim Maxim
Deviat p*
n an um um
ion

2 218,
Fentanyl 53,38 217,5 50 310
4 96
0,1
85 From the graph above can be seen that
2 191,
Oxycodone 80,997 200 65 365
4 87
the oxycodone group has a lower average VAS
*Mann-Whitney test
value than the fentanyl group in T1 - T7. In T0
Based on the above table it can be seen both groups have the same VAS. This is because
that the average duration of group operation
there are still effects of analgesic drugs used
given Fentanyl drugs was 218.96 53.38
minutes and the mean duration of group during surgery.
operation given Oxycodone drug was 191.87
80.10 minutes. Based on statistical tests with
Mann-Whitney test showed no difference in the
duration of surgery between the two study Discussion
subjects (p> 0.05).
This study assessed the effectiveness of
The average time difference to achieve VAS Oxycodone analgesics and continuous infusion
3 based on the given drug
fentanyl in monitoring post-operative pain in
n Waktu untuk mencapai VAS 3 (Jam)
long bones. From the sample characteristic data
it can be seen that the age between the two hysterectomy surgery in terms of oxycodone
sample groups did not have statistically consumption accumulation, pain control and
significant difference, thus the samples taken favorable effects related to price. This is in line
were relatively homogeneous (p> 0.05). with this study, where the use of Oxycodone by
Similarly, sex, ASA physical stattus, VAS Pre op continuous infusion is more effective in
and duration of operation between the two reducing VAS 3 compared with fentanyl use.
groups of samples were not statistically
This study did not assess the incidence
significant (p> 0.05).
of adverse events occurring from both drugs. In
Based on statistical test of the average further studies, an assessment of possible side
dose used to achieve VAS 3 it was found that effects may be possible due to the use of this
the mean dose of fentanyl group drug group was drug.
0.4058 0.054 mcg more than the group given
Oxycodone as much as 1.46 0.51 mg.
Statistical tests with MANN Whitney test
showed significant differences between the two
groups (p <0.05).

From the results of clinical trials showed


that the Oxycodone group proved to require a
faster time to achieve VAS 3 with a mean time
of 1.46 hours compared with the fentanyl group
with an average time of 2.58 hours. Mann-
Whitney test results in this study also showed
that the average dose of drugs produced in the
Oxycodone group had a smaller dose range of
1.46 0.51 mg compared with fentanyl of
0.4058 0.054 mcg.

A study conducted by KIM in 2014


found that Oxycodone IV-PCA was more
favorable than IV-PCA fentanyl for laparoscopic