Oxycodone for analgesia in children undergoing endoscopic retrograde cholangiopancreatography: a randomized, double-blind, parallel study

Wei Ji; Liping Sun; Yue Huang; Jie Bai; Jijian Zheng; Kan Zhang

doi:10.3389/fphar.2024.1515501

Oxycodone for analgesia in children undergoing endoscopic retrograde cholangiopancreatography: a randomized, double-blind, parallel study

Front Pharmacol. 2025 Jan 8:15:1515501. doi: 10.3389/fphar.2024.1515501. eCollection 2024.

Authors

Wei Ji^{1

2}, Liping Sun^{1

2}, Yue Huang^{1

2}, Jie Bai^{1

2}, Jijian Zheng^{1

2}, Kan Zhang^{1

2}

Affiliations

¹ Department of Anesthesiology and Pediatric Clinical Pharmacology Laboratory, Shanghai Children's Medical Center, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
² National Children's Medical Center, Shanghai, China.

Abstract

Background: Postoperative visceral pain is a common complication after endoscopic retrograde cholangiopancreatography (ERCP). In this study, we compared the analgesic and anti-inflammatory effects of oxycodone and fentanyl in children undergoing ERCP.

Methods: A single-center, randomized, double-blind study was conducted at a tertiary care hospital affiliated with Shanghai Jiao Tong University. Eighty-two pediatric patients aged 2-18 years who were scheduled for elective ERCP were randomly assigned to receive either oxycodone (0.2 mg/kg) or fentanyl (2 μg/kg). The postoperative pain was evaluated after 10 min, 20 min, and 30 min in the post-anesthesia care unit (PACU) as well as 6 h and 24 h in the ward following ERCP. Additionally, inflammatory cytokines in the serum, including tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-10 were examined by blood sampling at baseline, 6 h, and 24 h after ERCP.

Results: Compared to fentanyl, children receiving oxycodone had significantly lower pain scores at 30 min, 6 h, and 24 h after ERCP, while the scores at 10 and 20 min were similar in both groups. We also found that fewer patients had pain scores ≥3 at 6 h and 24 h after the procedure in the oxycodone group [36.6% (15/41) vs. 61.0% (25/41) at 6 h, 34.1% (14/41) vs. 58.5% (24/41) at 24 h, p = 0.027 for both cases]. Furthermore, fewer children in the oxycodone group had elevated inflammatory cytokines (IL-6 at 6 h and TNF-α at 24 h after ERCP) compared to the fentanyl group. The incidence of postoperative vomiting was also lower among children receiving oxycodone [14.1% (7/41) vs. 24.4% (10/41), p = 0.032].

Conclusion: Oxycodone (0.2 mg kg^-1) can provide effective analgesia and stable hemodynamics in children undergoing ERCP. This analgesic characteristic may be related to amelioration of inflammation after ERCP.

Clinical trial registration: www.chictr.org.cn, identifier ChiCTR2300074473.

Keywords: children; endoscopic retrograde cholangiopancreatography (ERCP); inflammation; oxycodone; visceral pain.

Grants and funding

The authors declare that financial support was received for the research, authorship, and/or publication of this article. This work was funded by the Beijing Kangmeng Charity Foundation (grant number: KM-20221226-01).