A Comparative Analysis of Transitional Analgesia with Oxycodone and Sufentanil in Patients with Early Esophageal Carcinoma Undergoing Endoscopic Submucosal Dissection

A Comparative Analysis of Transitional Analgesia with Oxycodone and Sufentanil in Patients with Early Esophageal Carcinoma Undergoing Endoscopic Submucosal Dissection | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Comparative Analysis of Transitional Analgesia with Oxycodone and Sufentanil in Patients with Early Esophageal Carcinoma Undergoing Endoscopic Submucosal Dissection Meirong Gu, Wenyi Chen, Xiaowen Wu, Tianjun Wu, Xin Zhang, Yiling Qian This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4051412/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Postoperative pain management is a critical consideration in patients undergoing endoscopic submucosal dissection (ESD) for early esophageal carcinoma. Conventional transitional analgesia methods involve the administration of either oxycodone or sufentanil. However, the efficacy of oxycodone in the context of patients with early esophageal carcinoma undergoing ESD under general anesthesia remains uncertain. This study aims to compare the postoperative analgesic effects of oxycodone and sufentanil in patients undergoing ESD for early esophageal carcinoma patients under general anesthesia. Methods: In this randomized double-blind controlled study, 86 patients scheduled for ESD surgery under general anesthesia were enrolled. They were randomly assigned to the oxycodone group (O group, n = 29), sufentanil group (S group, n = 30), or normal saline group (N group, n = 26) using a double-blind method. Thirty minutes before the end of the surgery, patients in the O group received oxycodone (0.1 mg/kg), those in the S group received sufentanil (0.1 μg/kg), and those in the N group received an identical volume of normal saline. Various parameters, including general patient conditions, intraoperative anesthetic medication, vital sign variations throughout the perioperative period, postoperative recovery duration, decannulation time, and adverse reactions during the recovery period were meticulously recorded. Visual Analog Scale (VAS) scores at rest and during movement at 0 h, 12 h, and 24 h post-surgery, along with the incidence of pain relief and malignant vomiting, were also documented. Results: No statistically significant differences were observed in general patient conditions, intraoperative anesthetic dosages, or vital sign changes among the three groups. However, patients in the O group exhibited significantly prolonged recovery and decannulation times compared to the S and N groups,without impeding overall recovery. Statistically significant differences in adverse reactions during the recovery period were observed ( P <0.05). Furthermore, patients in the O group demonstrated decreased VAS scores at 0 h, 12 h, and 24 h post-surgery, regardless of rest or movement, compared to the S and N groups. Although VAS scores in the S group were significantly reduced at postoperative 0 h and 12 h at rest compared to the N group, no significant differences were noted in the reduction of VAS scores during movement. The incidence of severe vomiting did not significantly differ among the three postoperative groups. Conclusion: When compared with sufentanil, oxycodone exhibited more prolonged and comprehensive analgesic effects in patients undergoing esophageal ESD under general anesthesia, with no significant side effects. These findings contribute to our understanding of transitional analgesia strategies in this specific patient population. Postoperative pain esophageal ESD oxycodone sufentanil Figures Figure 1 Figure 2 Figure 3 Figure 4 Background Esophageal cancer, characterized by its malignant nature and prevalence, arises from the esophageal epithelium, posing a significant clinical challenge due to its insidious symptoms [1] . The diagnosis of early esophageal carcinoma remains intricate, but advancements in digestive endoscopy, particularly endoscopic submucosal dissection (ESD), have substantially improved diagnostic rates and therapeutic efficacy, particularly in cases of early esophageal cancer. ESD offers the advantages of low trauma, high resection rates, and enhanced safety [2] . Despite these advancements, postoperative pain following ESD is a frequently overlooked clinical complication [3] . The potential for moderate to severe pain not only extends hospitalization but also adversely impacts the quality of life for affected individuals [4] . Timely intervention during the perioperative period is crucial to mitigate the risk of significant post-ESD pain in patients with early esophageal cancer. Sufentanil, a primary drug for general anesthesia and postoperative analgesia, primarily targets μ receptors, exhibiting well-established analgesic efficacy and safety [5] . However, escalating drug dosages may lead to undesirable side effects such as respiratory depression [6] , nausea, vomiting, and urinary retention. Oxycodone, a semi-synthetic opioid derived from tiabaine, activates μ receptors, effectively alleviating acute incision pain. Moreover, its activation of κ receptors, widely distributed in visceral smooth muscles, raises the threshold of visceral pain [7] . Despite debates on oxycodone's efficacy in clinical practice, animal experiments and clinical studies support its superiority, leading to its increased perioperative use. In comparison to sufentanil, oxycodone boasts a quicker onset and prolonged action duration [8] . Combining oxycodone with sufentanil may mitigate adverse reactions while enhancing overall benefits [9] . Although ESD is minimally invasive, acute incision pain and visceral pain remain common in clinical scenarios, demanding effective resolution. A noticeable gap exists in the literature concerning oxycodone's application for transitional analgesia in patients with early esophageal carcinoma undergoing ESD under general anesthesia. This study aims to establish the hypothesis that oxycodone can effectively alleviate postoperative pain in ESD patients with early esophageal carcinoma. Additionally, we seek to compare the analgesic effects of oxycodone with those of sufentanil in patients diagnosed with early esophageal cancer undergoing ESD under general anesthesia. Through this investigation, we aim to contribute valuable insights to the optimal perioperative management of pain in this specific patient population. Methods The present study received approval from the Institutional Research Ethics Committee of Wuxi People’s Hospital, Nanjing Medical University, and was registered in the Chinese Clinical Trial Registry (ChiCTR2200064865). Informed written consent was obtained from all eligible patients. The study adhered to the principles outlined in the Helsinki Declaration and followed the Consolidated Standards of Reporting Trials (CONSORT) guidelines. A total of 96 adult patients with American Society of Anesthesiologists (ASA) physical status I or II, scheduled for elective endoscopic submucosal dissection (ESD) under general anesthesia at the Affiliated Wuxi People’s Hospital of Nanjing Medical University between June 2022 and May 2023, were recruited. Exclusion criteria included severe systemic diseases, heart disease, hepatopathy or nephropathy, coagulation dysfunction, submucosal infiltration, acute or chronic pain, alcohol or opioid dependence, and allergy to trial agents. Patients were randomly assigned into the oxycodone group (Group O), sufentanil group (Group S), and saline group (Group N) using a computer-generated randomization list, ensuring no premedication. Routine monitoring in the operating theater included noninvasive blood pressure (NBP), pulse oxygen saturation (SpO 2 ), electrocardiograms (ECGs), and bispectral index (BIS). Cannulation via the median cubital vein of the forearm with a 20G venous trocar needle was performed, followed by induction of general anesthesia with midazolam 2 mg, sufentanil (0.4 μg/kg), propofol (2.5 mg/kg), and cis-atracurium (0.25 mg/kg). Endotracheal intubation was carried out five minutes later using a GlideScope. Maintenance of general anesthesia involved propofol (4–6 mg/kg/h), remifentanil (0.1–0.3 μg/kg/min), and cis-atracurium as needed, with anesthesia targeted to maintain BIS between 40 and 60, ensuring no body movements throughout the operation. Blood pressure (BP) and heart rate (HR) were stabilized within ± 20% of baseline. Thirty minutes before the operation's conclusion, oxycodone 0.1 mg/kg (diluted to 1 mg/ml with normal saline) was administered in Group O, sufentanil 0.1 μg/kg (diluted to 0.1 μg/ml with normal saline) in Group S, and an identical volume of normal saline in Group N. Mean arterial pressure (MAP), heart rate (HR), and pulse oxygen saturation (SPO 2 ) were recorded at various time points: T1 (baseline, prior to general anesthesia), T2 (30 min before the operation's termination, at the time of analgesic administration), T3 (end of operation), and T4 (5 min after intubation before returning to the inpatient department). Anesthetic dosages and postoperative reactions were documented, including depressed respiration, vertigo, lethargy, delayed emergence, and restlessness. Postoperative incision pain was assessed using the Visual Analog Scale (VAS) at T1, T2, and T3. Additionally, the incidence of postoperative nausea and vomiting (PONV) and remedial analgesia within 24 hours postoperatively were recorded. Statistical Analysis GraphPad software (Boston, USA) was utilized for the statistical analysis of the data obtained in this study. Normal distribution of the presented data was assessed using the Kolmogorov–Smirnov test. Measurement data are expressed as the mean ± standard deviation, and intergroup differences were assessed using One-way Analysis of Variance (ANOVA). Additionally, the data were characterized using interquartile range. Categorical data, presented as absolute or relative effect sizes, were analyzed using the chi-square test or Fisher’s exact test. A significance level of P < 0.05 was considered statistically significant. Results A total of 96 adult patients with ASA physical status I or II, aged between 55 and 78 years, weighing 47.5–93 kg, and with BMIs ranging from 15.3 to 29 kg/m 2 , were initially enrolled in the study. Three patients did not meet the inclusion criteria, and an additional three patients were excluded for other reasons, as illustrated in Figure 1. Consequently, 90 patients were enrolled, but one failed to follow up due to the inability to describe postoperative pain. In the oxycodone group, 29 patients were included, while 30 patients were recruited in the sufentanil group. In the control (normal saline) group, one patient failed to follow up due to intraoperative esophageal perforation, one patient presented with postoperative bleeding, and one was unable to describe postoperative pain, resulting in 27 cases ultimately included (Figure 1). The characteristics of the patients, as well as surgery and anesthesia profiles, were compared among the groups, revealing no statistically significant differences (p > 0.05) (Table 1). Medication quantities and perioperative complications are detailed in Table 2, with no observed statistical significance among the groups. Table 1: Data were expressed as mean±SD, Group O Group Oxycodone, Group S Group Sufentanil, Group N normal saline group; BMI body mass index, ASA American Society of Anesthesiologists physical status Table 2: Data were expressed as mean±SD. Y yes, N no No significant differences were noted in mean arterial pressure (MAP), heart rate (HR), pulse oxygen saturation (SPO 2 ), and bispectral index (BIS) at time points T1, T2, T3, and T4 (Table 3). Evaluation of visceral pain at rest or in movement at 0h, 12h, and 24h post-operation revealed notable differences. In the rest state, the sufentanil group did not exhibit satisfactory analgesic effects at each time point, whereas the VAS score of the oxycodone group demonstrated significant statistical differences compared to the saline group. In the movement state, the sufentanil group showed slightly modest analgesic effects at 0h and 12h compared to the saline group, with no statistically significant difference at 24h. Conversely, the oxycodone group consistently demonstrated potent analgesic effects at each time point, markedly surpassing the sufentanil group (Figure 2). Figure 3 illustrates the quartile of data in each group. Table 3: Data were expressed as mean±SD. P -value < 0.05 statistically significant, HR heart rate, MAP Mean arterial pressure, SPO 2 pulse oxygen saturation, BIS bispectral index The comparison of reactions and complications during the recovery period in the three groups is presented in Table 4. The awakening and decannulation duration of the oxycodone group were slightly longer compared to the other two groups, showing statistically significant differences (Figure 4). However, no statistically significant differences were observed Postoperative malignant vomiting (PONV), a serious side effect of opioid medications. Despite the evident difference in postoperative VAS scores, the utilization rate of postoperative salvage analgesia showed no statistical significance in each group (Table5). Table 4: P -value < 0.05 statistically significant Table 5: P -value < 0.05 statistically significant, PONV postoperative nausea and vomiting Discussion Patients undergoing endoscopic submucosal dissection (ESD) for early esophageal cancer commonly experience substantial postoperative pain [10] , necessitating effective pain management strategies. In this study, we explored the analgesic efficacy and side effects of opioid analgesics, specifically oxycodone and sufentanil, during ESD surgery. Postoperative pain was assessed at 0h, 12h, and 24h using Visual Analog Scale (VAS) scores [11] . The results revealed that the oxycodone group consistently exhibited superior analgesic effects compared to the sufentanil and saline groups at all time points, regardless of rest or movement status (Figure 2). Quartile descriptive statistics further indicated that, compared with the sufentanil group, the oxycodone group demonstrated more significant VAS scores in the movement state at 0h and 12h postoperatively (Figure 3). Notably, both oxycodone and sufentanil, as opioid agonists, have been recognized as classic perioperative analgesics, with distinct receptor activation profiles—oxycodone primarily activating the κ receptor [12] and sufentanil predominantly activating the μ receptor [13] . Our findings align with existing research, emphasizing oxycodone's superior analgesic effects [14] . The study focused on ESD patients experiencing inherent visceral pain [15] , where oxycodone's κ receptor activation demonstrated efficacy. Administering low doses of both oxycodone (0.1 mg/kg) and sufentanil (0.1 μg/kg) at 30 minutes post-operation demonstrated comparable efficacy. Oxycodone exhibited advantages within the first 24 hours after surgery, showcasing a longer analgesic duration [16] than sufentanil [17] , encompassing the entire 24-hour period, while sufentanil's effect lasted only up to 12 hours. Oxycodone also displayed efficacy in both rest and movement states, suggesting improved sleep and sedation at rest, potentially contributing to better recovery [18] . Additionally, oxycodone demonstrated superior analgesic effects in the movement state within 12 hours after surgery, facilitating early patient mobility and accelerating Enhanced Recovery After Surgery (ERAS) recovery [19] . Concerning side effects, decannulation time and recovery time were statistically significant in the oxycodone group compared to other groups, without causing delayed recovery. This could be attributed to oxycodone's sedative effect through κ receptor activation [20] . Postoperative malignant vomiting (PONV), a serious side effect in this patient population [21] , did not exhibit statistical differences in the oxycodone group compared to the other groups. Despite consistent high VAS scores in the saline group, there were no statistical differences in the utilization rate of postoperative salvage analgesia. This aspect may warrant further investigation into the pain relief process in the ward. Sufentanil, while exhibiting analgesic effects, appeared suboptimal compared to oxycodone in this study. Limitations include a predominantly male participant population, necessitating further investigation into potential gender differences in oxycodone metabolism in female patients [22] . Moreover, surgical factors such as lesion location and circumference ratio, which may influence pain [23] , were not comprehensively explored and warrant future investigation. Conclusion In conclusion, our study demonstrates that, when compared with sufentanil, oxycodone offers more prolonged and comprehensive analgesic effects in patients undergoing endoscopic submucosal dissection (ESD) for early esophageal carcinoma. Importantly, this enhanced analgesic efficacy does not come at the cost of increased side effects. The intravenous injection of oxycodone administered 30 minutes prior to the conclusion of the operation consistently provided superior analgesic effects for patients undergoing ESD under general anesthesia. This transition from anesthesia with sufentanil to analgesia with oxycodone represents a promising clinical approach. However, to establish its widespread applicability, further validation through multi-centered large-sample clinical trials is imperative. These findings contribute valuable insights into optimizing pain management strategies for patients with early esophageal carcinoma undergoing ESD, highlighting the role of oxycodone transitionally combined with sufentanil therapy in enhanced recovery in digestive endoscopic surgery. Abbreviations ASA: American Society of Anesthesiologists; ANOVA: One-way Analysis of Variance; BIS: bispectral index; BMI: body mass index; BP: blood pressure; CONSORT: Consolidated Standards of Reporting Trials; ECGs: electrocardiograms; ESD: endoscopic submucosal dissection; HR: heart rate; MAP: mean arterial pressure; NBP: noninvasive blood pressure; N group: normal saline group; O group: oxycodone group; S group: sufentanil group; PONV: postoperative nausea and vomiting; SpO 2 : pulse oxygen saturation ; VAS: Visual Analog Scale; Declarations Acknowledgements Thank you to Pan Li and Ying Zhuang for their contributions to the edition of this manuscript. Authors ’ contributions YQ and XZ: Designed the study, wrote the protocol, and were the guarantors of this work and had full access to the data. MG and WC: Perform the clival trial and data colletion. XW and TW: data collection and analyses. All authors contributed to the article and approved the submitted version. Funding The study was funded by National Natural Science Foundation of China (82201378 YQ), and National Natural Science Foundation of China (82271251 X.Z), Jiangsu Distinguished Medical Expert Project (X.Z) and Jiangsu Health Innovation Team Project (X.Z). Availability of data and materials All data applied or analyzed in the present study are available from the corresponding author on reasonable request. Ethics approval and consent to participate This randomized double-blind controlled study was conducted at the Affiliated Wuxi People’s Hospital of Nanjing Medical University between June 2022 and May 2023, with the approval from the Institutional Research Ethics Committee of Wuxi People’s Hospital, Nanjing Medical University, and the registration of the Chinese Clinical Trial Registry (ChiCTR2200064865). The study adhered to the principles outlined in the Helsinki Declaration and followed the Consolidated Standards of Reporting Trials (CONSORT) guidelines. The written informed consents were obtained from all patients before enrolled. Consent for publication Not applicable. Competing interests No conflict of interest exists in the submission of this manuscript. References KELLY RJ. Emerging Multimodality Approaches to Treat Localized Esophageal Cancer. J Natl Compr Canc Netw. 2019; 17(8): 1009-1014. DRAGANOV PV, WANG AY, OTHMAN MO, et al. 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Lesion size and circumferential range identified as independent risk factors for esophageal stricture after endoscopic submucosal dissection. Surg Endosc. 2020; 34(9): 4065-4071. Tables Tables 1 to 5 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table1.tif Table2.tif Table3.tif Table4.tif Table5.tif Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4051412","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":277582562,"identity":"244dc123-22ab-4a5c-969a-d16b864023c1","order_by":0,"name":"Meirong Gu","email":"","orcid":"","institution":"The affiliated Wuxi People’s Hospital of Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Meirong","middleName":"","lastName":"Gu","suffix":""},{"id":277582564,"identity":"f1fc5007-5219-4da6-ab74-3334aadd0b78","order_by":1,"name":"Wenyi Chen","email":"","orcid":"","institution":"The affiliated Wuxi People’s Hospital of Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Wenyi","middleName":"","lastName":"Chen","suffix":""},{"id":277582566,"identity":"36d8c138-d0a7-449e-aced-df4b72aec92c","order_by":2,"name":"Xiaowen Wu","email":"","orcid":"","institution":"The affiliated Wuxi People’s Hospital of Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xiaowen","middleName":"","lastName":"Wu","suffix":""},{"id":277582568,"identity":"f03a7888-5425-4f5f-bbcf-5be485883ae4","order_by":3,"name":"Tianjun Wu","email":"","orcid":"","institution":"The affiliated Wuxi People’s Hospital of Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Tianjun","middleName":"","lastName":"Wu","suffix":""},{"id":277582570,"identity":"3af2fa76-669d-44ab-882e-39fb88f5e6e1","order_by":4,"name":"Xin Zhang","email":"","orcid":"","institution":"The affiliated Wuxi People’s Hospital of Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xin","middleName":"","lastName":"Zhang","suffix":""},{"id":277582571,"identity":"cf02205b-1667-44e4-ba5d-2e9751e554cc","order_by":5,"name":"Yiling Qian","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4ElEQVRIiWNgGAWjYFAC5oYDHyr+yzEwHADziNHC2HhwxhlmY5K0NB/mbWNObIDaSVgD343EhsM8Z9jStzOeTpNgqLBObGA/ewCvFkmgloNzKnhydzac3SbBcCY9sYEnLwGvFgOglgNvzkjkbjgA1MLYdjixQYLHgLAW3jaDdAOwln9EajnI25aQANHSQIQWyTMPG4CBfMAQ6LDNFgnH0o3beHLwa+E7nnz4w4eKA/IGN85uvPGhxlq2n/0Mfi0MFxKgDIkDDAwgNht+9UBw/gCUwd9AUO0oGAWjYBSMUAAAY4NWcck/UIcAAAAASUVORK5CYII=","orcid":"","institution":"The affiliated Wuxi People’s Hospital of Nanjing Medical University","correspondingAuthor":true,"prefix":"","firstName":"Yiling","middleName":"","lastName":"Qian","suffix":""}],"badges":[],"createdAt":"2024-03-09 04:16:32","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4051412/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4051412/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":52448101,"identity":"26c8b8eb-2bda-47fc-8be8-b1eb1d4b9238","added_by":"auto","created_at":"2024-03-11 18:35:26","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":95300,"visible":true,"origin":"","legend":"\u003cp\u003eCONSORT flow diagram.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-4051412/v1/53fc70a4a41f6c189d0b2787.png"},{"id":52448103,"identity":"a6050354-fbeb-4b2e-b746-78e2910da151","added_by":"auto","created_at":"2024-03-11 18:35:26","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":88973,"visible":true,"origin":"","legend":"\u003cp\u003ePostoperative VAS scores at 0h, 12h and 24h in three groups at rest and movement state. In the rest state, the VAS score of sufentanil group showed no statistic siginificance versus the normal saline group at 0h, 12h and 24h, whereas the VAS score of the oxycodone group demonstrated significantly decreased compared to the saline group；In the movement state, the VAS scores of the sufentanil group showed slightly decreased at 0h and 12h compared to the saline group, with no statistically significant difference at 24h; The VAS scores of the oxycodone group significantly decreased versus the sufentanil group and the normal saline group at each time point.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-4051412/v1/87449e9f8ad111577bbea068.png"},{"id":52448105,"identity":"7bbba73f-8b35-4c2e-afdd-43355af0f735","added_by":"auto","created_at":"2024-03-11 18:35:26","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":193393,"visible":true,"origin":"","legend":"\u003cp\u003eThe quartile of data in the oxycodone group, the sufentanil group and the normal saline group at rest and movement state at 0h, 12h and 24h.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-4051412/v1/7f98aa16482d81c8bdccb094.png"},{"id":52448106,"identity":"c16d4bd6-9ca5-4d4f-8cd4-64238f8284ec","added_by":"auto","created_at":"2024-03-11 18:35:26","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":111387,"visible":true,"origin":"","legend":"\u003cp\u003eThe decannulation time and wake-up time of the oxycodone group were significantly longer compared to the sufentanil group and the normal saline group.\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-4051412/v1/5776dcd9d98a81757a716e3a.png"},{"id":53138132,"identity":"477ef45c-6be2-4bd4-93f1-e3c4580ed620","added_by":"auto","created_at":"2024-03-21 05:15:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":624744,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4051412/v1/a545a981-bc0b-4c67-bb45-9b7eb84548b2.pdf"},{"id":52448100,"identity":"3941c269-7957-4d54-a777-85c88dbb785c","added_by":"auto","created_at":"2024-03-11 18:35:25","extension":"tif","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":180518,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.tif","url":"https://assets-eu.researchsquare.com/files/rs-4051412/v1/63db888792cd184d27c82977.tif"},{"id":52448109,"identity":"7bbcee00-70d6-4ab7-8d21-ffb92bb5a06a","added_by":"auto","created_at":"2024-03-11 18:35:26","extension":"tif","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":162026,"visible":true,"origin":"","legend":"","description":"","filename":"Table2.tif","url":"https://assets-eu.researchsquare.com/files/rs-4051412/v1/c252679c9b3a82f443d74966.tif"},{"id":52448108,"identity":"23fe736b-7f7b-4723-b348-7515576cf066","added_by":"auto","created_at":"2024-03-11 18:35:26","extension":"tif","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":221022,"visible":true,"origin":"","legend":"","description":"","filename":"Table3.tif","url":"https://assets-eu.researchsquare.com/files/rs-4051412/v1/9b54ae96b426d3388e95f2fe.tif"},{"id":52448107,"identity":"122573b9-25c3-45b3-b82c-8cbf4089f2ba","added_by":"auto","created_at":"2024-03-11 18:35:26","extension":"tif","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":143820,"visible":true,"origin":"","legend":"","description":"","filename":"Table4.tif","url":"https://assets-eu.researchsquare.com/files/rs-4051412/v1/92c81911078b1a90d7394f89.tif"},{"id":52448104,"identity":"297ed1f2-26dd-4d3e-a9f2-876349ae9ff5","added_by":"auto","created_at":"2024-03-11 18:35:26","extension":"tif","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":117624,"visible":true,"origin":"","legend":"","description":"","filename":"Table5.tif","url":"https://assets-eu.researchsquare.com/files/rs-4051412/v1/b42e56de2fddfd4ba0be4c2a.tif"}],"financialInterests":"No competing interests reported.","formattedTitle":"A Comparative Analysis of Transitional Analgesia with Oxycodone and Sufentanil in Patients with Early Esophageal Carcinoma Undergoing Endoscopic Submucosal Dissection","fulltext":[{"header":"Background","content":"\u003cp\u003eEsophageal cancer, characterized by its malignant nature and prevalence, arises from the esophageal epithelium, posing a significant clinical challenge due to its insidious symptoms\u003csup\u003e[1]\u003c/sup\u003e. The diagnosis of early esophageal carcinoma remains intricate, but advancements in digestive endoscopy, particularly endoscopic submucosal dissection (ESD), have substantially improved diagnostic rates and therapeutic efficacy, particularly in cases of early esophageal cancer. ESD offers the advantages of low trauma, high resection rates, and enhanced safety\u003csup\u003e[2]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eDespite these advancements, postoperative pain following ESD is a frequently overlooked clinical complication\u003csup\u003e[3]\u003c/sup\u003e. The potential for moderate to severe pain not only extends hospitalization but also adversely impacts the quality of life for affected individuals\u003csup\u003e[4]\u003c/sup\u003e. Timely intervention during the perioperative period is crucial to mitigate the risk of significant post-ESD pain in patients with early esophageal cancer.\u003c/p\u003e\n\u003cp\u003eSufentanil, a primary drug for general anesthesia and postoperative analgesia, primarily targets \u0026mu; receptors, exhibiting well-established analgesic efficacy and safety\u003csup\u003e[5]\u003c/sup\u003e. However, escalating drug dosages may lead to undesirable side effects such as respiratory depression\u003csup\u003e[6]\u003c/sup\u003e, nausea, vomiting, and urinary retention. Oxycodone, a semi-synthetic opioid derived from tiabaine, activates \u0026mu; receptors, effectively alleviating acute incision pain. Moreover, its activation of \u0026kappa; receptors, widely distributed in visceral smooth muscles, raises the threshold of visceral pain\u003csup\u003e[7]\u003c/sup\u003e. Despite debates on oxycodone\u0026apos;s efficacy in clinical practice, animal experiments and clinical studies support its superiority, leading to its increased perioperative use.\u003c/p\u003e\n\u003cp\u003eIn comparison to sufentanil, oxycodone boasts a quicker onset and prolonged action duration\u003csup\u003e[8]\u003c/sup\u003e. Combining oxycodone with sufentanil may mitigate adverse reactions while enhancing overall benefits\u003csup\u003e[9]\u003c/sup\u003e. Although ESD is minimally invasive, acute incision pain and visceral pain remain common in clinical scenarios, demanding effective resolution. A noticeable gap exists in the literature concerning oxycodone\u0026apos;s application for transitional analgesia in patients with early esophageal carcinoma undergoing ESD under general anesthesia.\u003c/p\u003e\n\u003cp\u003eThis study aims to establish the hypothesis that oxycodone can effectively alleviate postoperative pain in ESD patients with early esophageal carcinoma. Additionally, we seek to compare the analgesic effects of oxycodone with those of sufentanil in patients diagnosed with early esophageal cancer undergoing ESD under general anesthesia. Through this investigation, we aim to contribute valuable insights to the optimal perioperative management of pain in this specific patient population.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe present study received approval from the Institutional Research Ethics Committee of Wuxi People\u0026rsquo;s Hospital, Nanjing Medical University, and was registered in the Chinese Clinical Trial Registry (ChiCTR2200064865). Informed written consent was obtained from all eligible patients. The study adhered to the principles outlined in the Helsinki Declaration and followed the Consolidated Standards of Reporting Trials (CONSORT) guidelines.\u003c/p\u003e\n\u003cp\u003eA total of 96 adult patients with American Society of Anesthesiologists (ASA) physical status I or II, scheduled for elective endoscopic submucosal dissection (ESD) under general anesthesia at the Affiliated Wuxi People\u0026rsquo;s Hospital of Nanjing Medical University between June 2022 and May 2023, were recruited. Exclusion criteria included severe systemic diseases, heart disease, hepatopathy or nephropathy, coagulation dysfunction, submucosal infiltration, acute or chronic pain, alcohol or opioid dependence, and allergy to trial agents.\u003c/p\u003e\n\u003cp\u003ePatients were randomly assigned into the oxycodone group (Group O), sufentanil group (Group S), and saline group (Group N) using a computer-generated randomization list, ensuring no premedication. Routine monitoring in the operating theater included noninvasive blood pressure (NBP), pulse oxygen saturation (SpO\u003csub\u003e2\u003c/sub\u003e), electrocardiograms (ECGs), and bispectral index (BIS). Cannulation via the median cubital vein of the forearm with a 20G venous trocar needle was performed, followed by induction of general anesthesia with midazolam 2 mg, sufentanil (0.4 \u0026mu;g/kg), propofol (2.5 mg/kg), and cis-atracurium (0.25 mg/kg). Endotracheal intubation was carried out five minutes later using a GlideScope.\u003c/p\u003e\n\u003cp\u003eMaintenance of general anesthesia involved propofol (4\u0026ndash;6 mg/kg/h), remifentanil (0.1\u0026ndash;0.3 \u0026mu;g/kg/min), and cis-atracurium as needed, with anesthesia targeted to maintain BIS between 40 and 60, ensuring no body movements throughout the operation. Blood pressure (BP) and heart rate (HR) were stabilized within \u0026plusmn; 20% of baseline. Thirty minutes before the operation\u0026apos;s conclusion, oxycodone 0.1 mg/kg (diluted to 1 mg/ml with normal saline) was administered in Group O, sufentanil 0.1 \u0026mu;g/kg (diluted to 0.1 \u0026mu;g/ml with normal saline) in Group S, and an identical volume of normal saline in Group N.\u003c/p\u003e\n\u003cp\u003eMean arterial pressure (MAP), heart rate (HR), and pulse oxygen saturation (SPO\u003csub\u003e2\u003c/sub\u003e) were recorded at various time points: T1 (baseline, prior to general anesthesia), T2 (30 min before the operation\u0026apos;s termination, at the time of analgesic administration), T3 (end of operation), and T4 (5 min after intubation before returning to the inpatient department). Anesthetic dosages and postoperative reactions were documented, including depressed respiration, vertigo, lethargy, delayed emergence, and restlessness. Postoperative incision pain was assessed using the Visual Analog Scale (VAS) at T1, T2, and T3. Additionally, the incidence of postoperative nausea and vomiting (PONV) and remedial analgesia within 24 hours postoperatively were recorded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGraphPad software (Boston, USA) was utilized for the statistical analysis of the data obtained in this study. Normal distribution of the presented data was assessed using the Kolmogorov\u0026ndash;Smirnov test. Measurement data are expressed as the mean \u0026plusmn; standard deviation, and intergroup differences were assessed using One-way Analysis of Variance (ANOVA). Additionally, the data were characterized using interquartile range. Categorical data, presented as absolute or relative effect sizes, were analyzed using the chi-square test or Fisher\u0026rsquo;s exact test. A significance level of \u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 96 adult patients with ASA physical status I or II, aged between 55 and 78 years, weighing 47.5\u0026ndash;93 kg, and with BMIs ranging from 15.3 to 29 kg/m\u003csup\u003e2\u003c/sup\u003e, were initially enrolled in the study. Three patients did not meet the inclusion criteria, and an additional three patients were excluded for other reasons, as illustrated in Figure 1. Consequently, 90 patients were enrolled, but one failed to follow up due to the inability to describe postoperative pain. In the oxycodone group, 29 patients were included, while 30 patients were recruited in the sufentanil group. In the control (normal saline) group, one patient failed to follow up due to intraoperative esophageal perforation, one patient presented with postoperative bleeding, and one was unable to describe postoperative pain, resulting in 27 cases ultimately included (Figure 1).\u003c/p\u003e\n\u003cp\u003eThe characteristics of the patients, as well as surgery and anesthesia profiles, were compared among the groups, revealing no statistically significant differences (p \u0026gt; 0.05) (Table 1). Medication quantities and perioperative complications are detailed in Table 2, with no observed statistical significance among the groups.\u003c/p\u003e\n\u003cp\u003eTable 1: Data were expressed as mean\u0026plusmn;SD, Group O Group Oxycodone, Group S Group Sufentanil, Group N normal saline group; BMI body mass index, ASA American Society of Anesthesiologists physical status\u003c/p\u003e\n\u003cp\u003eTable 2: Data were expressed as mean\u0026plusmn;SD. Y yes, N no\u003c/p\u003e\n\u003cp\u003eNo significant differences were noted in mean arterial pressure (MAP), heart rate (HR), pulse oxygen saturation (SPO\u003csub\u003e2\u003c/sub\u003e), and bispectral index (BIS) at time points T1, T2, T3, and T4 (Table 3). Evaluation of visceral pain at rest or in movement at 0h, 12h, and 24h post-operation revealed notable differences. In the rest state, the sufentanil group did not exhibit satisfactory analgesic effects at each time point, whereas the VAS score of the oxycodone group demonstrated significant statistical differences compared to the saline group. In the movement state, the sufentanil group showed slightly modest analgesic effects at 0h and 12h compared to the saline group, with no statistically significant difference at 24h. Conversely, the oxycodone group consistently demonstrated potent analgesic effects at each time point, markedly surpassing the sufentanil group (Figure 2). Figure 3 illustrates the quartile of data in each group.\u003c/p\u003e\n\u003cp\u003eTable 3: Data were expressed as mean\u0026plusmn;SD. \u003cem\u003eP\u003c/em\u003e-value \u0026lt; 0.05 statistically significant, HR heart rate, MAP Mean arterial pressure, SPO\u003csub\u003e2\u003c/sub\u003e pulse oxygen saturation, BIS bispectral index\u003c/p\u003e\n\u003cp\u003eThe comparison of reactions and complications during the recovery period in the three groups is presented in Table 4. The awakening and decannulation duration of the oxycodone group were slightly longer compared to the other two groups, showing statistically significant differences (Figure 4). However, no statistically significant differences were observed Postoperative malignant vomiting (PONV), a serious side effect of opioid medications. Despite the evident difference in postoperative VAS scores, the utilization rate of postoperative salvage analgesia showed no statistical significance in each group (Table5).\u003c/p\u003e\n\u003cp\u003eTable 4: \u003cem\u003eP\u003c/em\u003e-value \u0026lt; 0.05 statistically significant\u003c/p\u003e\n\u003cp\u003eTable 5: \u003cem\u003eP\u003c/em\u003e-value \u0026lt; 0.05 statistically significant, PONV postoperative nausea and vomiting\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePatients undergoing endoscopic submucosal dissection (ESD) for early esophageal cancer commonly experience substantial postoperative pain\u003csup\u003e[10]\u003c/sup\u003e, necessitating effective pain management strategies. In this study, we explored the analgesic efficacy and side effects of opioid analgesics, specifically oxycodone and sufentanil, during ESD surgery.\u003c/p\u003e\n\u003cp\u003ePostoperative pain was assessed at 0h, 12h, and 24h using Visual Analog Scale (VAS) scores\u003csup\u003e[11]\u003c/sup\u003e. The results revealed that the oxycodone group consistently exhibited superior analgesic effects compared to the sufentanil and saline groups at all time points, regardless of rest or movement status (Figure 2). Quartile descriptive statistics further indicated that, compared with the sufentanil group, the oxycodone group demonstrated more significant VAS scores in the movement state at 0h and 12h postoperatively (Figure 3). Notably, both oxycodone and sufentanil, as opioid agonists, have been recognized as classic perioperative analgesics, with distinct receptor activation profiles\u0026mdash;oxycodone primarily activating the \u0026kappa; receptor\u003csup\u003e[12]\u003c/sup\u003e and sufentanil predominantly activating the \u0026mu; receptor\u003csup\u003e[13]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eOur findings align with existing research, emphasizing oxycodone\u0026apos;s superior analgesic effects\u003csup\u003e[14]\u003c/sup\u003e. The study focused on ESD patients experiencing inherent visceral pain\u003csup\u003e[15]\u003c/sup\u003e, where oxycodone\u0026apos;s \u0026kappa; receptor activation demonstrated efficacy. Administering low doses of both oxycodone (0.1 mg/kg) and sufentanil (0.1 \u0026mu;g/kg) at 30 minutes post-operation demonstrated comparable efficacy. Oxycodone exhibited advantages within the first 24 hours after surgery, showcasing a longer analgesic duration\u003csup\u003e[16]\u003c/sup\u003e than sufentanil\u003csup\u003e[17]\u003c/sup\u003e, encompassing the entire 24-hour period, while sufentanil\u0026apos;s effect lasted only up to 12 hours. Oxycodone also displayed efficacy in both rest and movement states, suggesting improved sleep and sedation at rest, potentially contributing to better recovery\u003csup\u003e[18]\u003c/sup\u003e. Additionally, oxycodone demonstrated superior analgesic effects in the movement state within 12 hours after surgery, facilitating early patient mobility and accelerating Enhanced Recovery After Surgery (ERAS) recovery\u003csup\u003e[19]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eConcerning side effects, decannulation time and recovery time were statistically significant in the oxycodone group compared to other groups, without causing delayed recovery. This could be attributed to oxycodone\u0026apos;s sedative effect through \u0026kappa; receptor activation\u003csup\u003e[20]\u003c/sup\u003e. Postoperative malignant vomiting (PONV), a serious side effect in this patient population\u003csup\u003e[21]\u003c/sup\u003e, did not exhibit statistical differences in the oxycodone group compared to the other groups.\u003c/p\u003e\n\u003cp\u003eDespite consistent high VAS scores in the saline group, there were no statistical differences in the utilization rate of postoperative salvage analgesia. This aspect may warrant further investigation into the pain relief process in the ward.\u003c/p\u003e\n\u003cp\u003eSufentanil, while exhibiting analgesic effects, appeared suboptimal compared to oxycodone in this study. Limitations include a predominantly male participant population, necessitating further investigation into potential gender differences in oxycodone metabolism in female patients\u003csup\u003e[22]\u003c/sup\u003e. Moreover, surgical factors such as lesion location and circumference ratio, which may influence pain\u003csup\u003e[23]\u003c/sup\u003e, were not comprehensively explored and warrant future investigation.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, our study demonstrates that, when compared with sufentanil, oxycodone offers more prolonged and comprehensive analgesic effects in patients undergoing endoscopic submucosal dissection (ESD) for early esophageal carcinoma. Importantly, this enhanced analgesic efficacy does not come at the cost of increased side effects.\u003c/p\u003e\n\u003cp\u003eThe intravenous injection of oxycodone administered 30 minutes prior to the conclusion of the operation consistently provided superior analgesic effects for patients undergoing ESD under general anesthesia. This transition from anesthesia with sufentanil to analgesia with oxycodone represents a promising clinical approach. However, to establish its widespread applicability, further validation through multi-centered large-sample clinical trials is imperative.\u003c/p\u003e\n\u003cp\u003eThese findings contribute valuable insights into optimizing pain management strategies for patients with early esophageal carcinoma undergoing ESD, highlighting the role of oxycodone transitionally combined with sufentanil therapy in enhanced recovery in digestive endoscopic surgery.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eASA: American Society of Anesthesiologists; ANOVA: One-way Analysis of Variance; BIS: bispectral index; BMI: body mass index; BP: blood pressure; CONSORT: Consolidated Standards of Reporting Trials; ECGs: electrocardiograms; ESD: endoscopic submucosal dissection; HR: heart rate; MAP: mean arterial pressure; NBP: noninvasive blood pressure; N group: normal saline group; O group: oxycodone group; S group: sufentanil group; PONV: postoperative nausea and vomiting; SpO\u003csub\u003e2\u003c/sub\u003e: pulse oxygen saturation ; VAS: Visual Analog Scale;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThank you to Pan Li and Ying Zhuang for their contributions to the edition of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u003c/strong\u003e\u003cstrong\u003e\u0026rsquo;\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003econtributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYQ and XZ: Designed the study, wrote the protocol, and were the guarantors of this work and had full access to the data. MG and WC: Perform the clival trial and data colletion. XW and TW: data collection and analyses. All authors contributed to the article and approved the submitted version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was funded by National Natural Science Foundation of China (82201378 YQ), and National Natural Science Foundation of China (82271251 X.Z), Jiangsu Distinguished Medical Expert Project (X.Z) and Jiangsu Health Innovation Team Project (X.Z).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data applied or analyzed in the present study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis randomized double-blind controlled study was conducted at the Affiliated Wuxi People\u0026rsquo;s Hospital of Nanjing Medical University between June 2022 and May 2023, with the approval from the Institutional Research Ethics Committee of Wuxi People\u0026rsquo;s Hospital, Nanjing Medical University, and the registration of the Chinese Clinical Trial Registry (ChiCTR2200064865). The study adhered to the principles outlined in the Helsinki Declaration and followed the Consolidated Standards of Reporting Trials (CONSORT) guidelines. The written informed consents were obtained from all patients before enrolled.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo conflict of interest exists in the submission of this manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKELLY RJ. Emerging Multimodality Approaches to Treat Localized Esophageal Cancer. J Natl Compr Canc Netw. 2019; 17(8): 1009-1014.\u003c/li\u003e\n\u003cli\u003eDRAGANOV PV, WANG AY, OTHMAN MO, et al. AGA Institute Clinical Practice Update: Endoscopic Submucosal Dissection in the United States. Clin Gastroenterol Hepatol.2019; 17(1): 16-25 e11.\u003c/li\u003e\n\u003cli\u003eSHAHIDI N, SCHOEMAN S, BOURKE MJ. Acute Epigastric Pain after Gastric Endoscopic Submucosal Dissection. Gastroenterology. 2020;158(4): e2-e3.\u003c/li\u003e\n\u003cli\u003eJUNG DH, YOUN YH, KIM JH, et al. Factors influencing development of pain after gastric endoscopic submucosal dissection: a randomized controlled trial. Endoscopy. 2015; 47(12): 1119-1123.\u003c/li\u003e\n\u003cli\u003eMACIEJEWSKI D. Sufentanil in anaesthesiology and intensive therapy. Anaesthesiol Intensive Ther.2012;44(1): 35-41.\u003c/li\u003e\n\u003cli\u003eBAILEY PL, STREISAND JB, EAST KA, et al. Differences in magnitude and duration of opioid-induced respiratory depression and analgesia with fentanyl and sufentanil. Anesth Analg. 1990; 70(1): 8-15.\u003c/li\u003e\n\u003cli\u003eARENDT-NIELSEN L, OLESEN AE, STAAHL C, et al. Analgesic efficacy of peripheral kappa-opioid receptor agonist CR665 compared to oxycodone in a multi-modal, multi-tissue experimental human pain model: selective effect on visceral pain. Anesthesiology. 2009;111(3): 616-624.\u003c/li\u003e\n\u003cli\u003eQUAN Z, LUO C, CHI P, et al. 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. Anesth Analg. 2018;127(2): 382-386.\u003c/li\u003e\n\u003cli\u003eRAEDER J. Opioids in the treatment of postoperative pain: old drugs with new options? Expert Opin Pharmacother. 2014; 15(4): 449-452.\u003c/li\u003e\n\u003cli\u003eHASHASH JG, EL-HADDAD A, BARADA K. Acute Epigastric Abdominal Pain Post-Gastric Polypectomy. Gastroenterology. 2018;154(4): e12-e14.\u003c/li\u003e\n\u003cli\u003eFERREIRA-VALENTE MA, PAIS-RIBEIRO JL, JENSEN MP. Validity of four pain intensity rating scales. Pain. 2011;152(10): 2399-2404.\u003c/li\u003e\n\u003cli\u003eUMUKORO NN, ARULDHAS BW, ROSSOS R, et al. Pharmacogenomics of oxycodone: a narrative literature review. Pharmacogenomics. 2021;22(5): 275-290.\u003c/li\u003e\n\u003cli\u003eSUN S, GUO Y, WANG T, et al. Analgesic Effect Comparison Between Nalbuphine and Sufentanil for Patient-Controlled Intravenous Analgesia After Cesarean Section. Front Pharmacol. 2020; 11(574493.\u003c/li\u003e\n\u003cli\u003eSCHMIDT-HANSEN M, BENNETT MI, ARNOLD S, et al. Oxycodone for cancer-related pain. Cochrane Database Syst Rev.2022; 6(6): CD003870.\u003c/li\u003e\n\u003cli\u003eSTAAHL C, CHRISTRUP LL, ANDERSEN SD, et al. A comparative study of oxycodone and morphine in a multi-modal, tissue-differentiated experimental pain model. Pain. 2006; 123(1-2): 28-36.\u003c/li\u003e\n\u003cli\u003eCOLUZZI F, MATTIA C. Oxycodone. Pharmacological profile and clinical data in chronic pain management. Minerva Anestesiol.2005;71(7-8): 451-460.\u003c/li\u003e\n\u003cli\u003eHAN L, SU Y, XIONG H, et al. Oxycodone versus sufentanil in adult patient-controlled intravenous analgesia after abdominal surgery: A prospective, randomized, double-blinded, multiple-center clinical trial. Medicine (Baltimore).2018;97(31): e11552.\u003c/li\u003e\n\u003cli\u003eRAFF M, BELBACHIR A, EL-TALLAWY S, et al. Intravenous Oxycodone Versus Other Intravenous Strong Opioids for Acute Postoperative Pain Control: A Systematic Review of Randomized Controlled Trials. Pain Ther.2019;8(1): 19-39.\u003c/li\u003e\n\u003cli\u003eNOEL E, MIGLIONICO L, LECLERCQ M, et al. Sufentanil sublingual tablet system versus oral oxycodone for management of postoperative pain in enhanced recovery after surgery pathway for total knee arthroplasty: a randomized controlled study. J Exp Orthop. 2020; 7(1): 92.\u003c/li\u003e\n\u003cli\u003eLIVINGSTON KE, TRAYNOR JR. Allostery at opioid receptors: modulation with small molecule ligands. Br J Pharmacol.2018;175(14): 2846-2856.\u003c/li\u003e\n\u003cli\u003eAUBERTIN J, DABIS F, FLEURETTE J, et al. Prevalence of legionellosis among adults: a study of community-acquired pneumonia in France. Infection.1987;15(5): 328-331.\u003c/li\u003e\n\u003cli\u003eKIMBROUGH A, KONONOFF J, SIMPSON S, et al. Oxycodone self-administration and withdrawal behaviors in male and female Wistar rats. Psychopharmacology (Berl). 2020;237(5): 1545-1555.\u003c/li\u003e\n\u003cli\u003eCHEN M, DANG Y, DING C, et al. Lesion size and circumferential range identified as independent risk factors for esophageal stricture after endoscopic submucosal dissection. Surg Endosc. 2020; 34(9): 4065-4071.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 5 are available in the Supplementary Files section.\u003c/p\u003e "}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Postoperative pain, esophageal ESD, oxycodone, sufentanil","lastPublishedDoi":"10.21203/rs.3.rs-4051412/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4051412/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Postoperative pain management is a critical consideration in patients undergoing endoscopic submucosal dissection (ESD) for early esophageal carcinoma. Conventional transitional analgesia methods involve the administration of either oxycodone or sufentanil. However, the efficacy of oxycodone in the context of patients with early esophageal carcinoma undergoing ESD under general anesthesia remains uncertain. This study aims to compare the postoperative analgesic effects of oxycodone and sufentanil in patients undergoing ESD for early esophageal carcinoma patients under general anesthesia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eIn this randomized double-blind controlled study, 86 patients scheduled for ESD surgery under general anesthesia were enrolled. They were randomly assigned to the oxycodone group (O group, n = 29), sufentanil group (S group, n = 30), or normal saline group (N group, n = 26) using a double-blind method. Thirty minutes before the end of the surgery, patients in the O group received oxycodone (0.1 mg/kg), those in the S group received sufentanil (0.1 μg/kg), and those in the N group received an identical volume of normal saline. Various parameters, including general patient conditions, intraoperative anesthetic medication, vital sign variations throughout the perioperative period, postoperative recovery duration, decannulation time, and adverse reactions during the recovery period were meticulously recorded. Visual Analog Scale (VAS) scores at rest and during movement at 0 h, 12 h, and 24 h post-surgery, along with the incidence of pain relief and malignant vomiting, were also documented.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e No statistically significant differences were observed in general patient conditions, intraoperative anesthetic dosages, or vital sign changes among the three groups. However, patients in the O group exhibited significantly prolonged recovery and decannulation times compared to the S and N groups,without impeding overall recovery. Statistically significant differences in adverse reactions during the recovery period were observed (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05). Furthermore, patients in the O group demonstrated decreased VAS scores at 0 h, 12 h, and 24 h post-surgery, regardless of rest or movement, compared to the S and N groups. Although VAS scores in the S group were significantly reduced at postoperative 0 h and 12 h at rest compared to the N group, no significant differences were noted in the reduction of VAS scores during movement. The incidence of severe vomiting did not significantly differ among the three postoperative groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e When compared with sufentanil, oxycodone exhibited more prolonged and comprehensive analgesic effects in patients undergoing esophageal ESD under general anesthesia, with no significant side effects. These findings contribute to our understanding of transitional analgesia strategies in this specific patient population.\u003c/p\u003e","manuscriptTitle":"A Comparative Analysis of Transitional Analgesia with Oxycodone and Sufentanil in Patients with Early Esophageal Carcinoma Undergoing Endoscopic Submucosal Dissection","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-11 18:35:21","doi":"10.21203/rs.3.rs-4051412/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4d96c0e7-10d8-45f8-b602-99ebe0677b86","owner":[],"postedDate":"March 11th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-07-04T13:02:39+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-11 18:35:21","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4051412","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4051412","identity":"rs-4051412","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}