Analgesic effects of oxycodone relative to those of sufentanil, in the presence of midazolam, during endoscopic injection sclerotherapy for patients with cirrhosis and esophageal varices
BACKGROUND: We evaluated the efficacy and gastroenterologist/patient satisfaction of midazolam combined with oxycodone, relative to that of midazolam combined with sufentanil, for anesthesia during endoscopic injection sclerotherapy (EIS) in patients with cirrhosis and esophageal varices. METHODS: Patients with cirrhosis (20-69 years of age), body mass index, 18-25 kg/m2, American Society of Anesthesiology patient classification physical status I-II who underwent elective EIS were randomly assigned to 1 of 2 groups. In this prospective, double-blinded, randomized controlled trial, 1 group received midazolam and oxycodone (n = 64), and the other group received midazolam and sufentanil (n = 63). Primary and secondary outcome measures were compared between groups. The primary outcome measure was the incidence of hypoxia. Secondary outcome measures included perioperative limb movement, need for rescue analgesics, need for additional sedative propofol, specified adverse reactions (postoperative myoclonus, nausea, vomiting, dizziness, and drowsiness), gastroenterologist satisfaction, and patient satisfaction with postoperative analgesia. RESULTS: Patients in the midazolam-oxycodone group had 32% fewer episodes of hypoxia than did those in the midazolam-sufentanil group (95% confidence interval [CI], -45% to -18%; P &lt; .001), 36.73% fewer perioperative limb movements (95% CI, -51.73% to -21.73%; P &lt; .001), 19.12% fewer required rescue analgesics (95% CI, -30.85% to -7.40%; P = .002), and less propofol requirement in the perioperative period (before EIS, -17.83%; 95% CI, -33.82% to -1.85%; P = .003; throughout EIS, -36.73%; 95% CI, -51.73% to -21.73%; P &lt; .001). The incidence rates for adverse reactions were similar between groups. Both the gastroenterologist and patients reported higher degrees of satisfaction with oxycodone than with sufentanil. CONCLUSIONS: Oxycodone in combination with midazolam may provide an anesthetic technique that results in fewer episodes of hypoxia and other adverse conditions during EIS. Copyright © 2018 International Anesthesia Research Society.