Appropriateness of oxycodone use for acute pain in surgical and obstetric departments using a clinical data warehouse

The use of oxycodone, recommended as a second-line treatment after morphine, has risen strongly over the last years. Considering its addictive potential, the aim of this study was to evaluate the appropriateness of use of oxycodone for acute pain.

A retrospective cross-sectional study was conducted using a university hospital clinical data warehouse and included all patients with at least one administration of oxycodone or morphine in surgery and obstetrics wards in 2022. The population was analysed using automatically collected data, and a random 100-patient sample was analysed through an extensive clinical record review.

The appropriate use of oxycodone implies four cumulative conditions which are represented by the primary outcomes carried out on the random 100-patient sample. Firstly, 74% of stays received oxycodone not preceded immediately by morphine: 21% had received oxycodone immediately after morphine, but 44% received oxycodone as first strong opioid and 27% received oxycodone combined with morphine as first opioid treatment, with justification found in less than 5%. Secondly, of the 1035 oxycodone administrations recorded in our sample, 398 (38.5%) were immediate-release forms administered for mild pain or without pain assessment. Thirdly, 28% were not combined with any other analgesic (no multimodal analgesia) and 42% were combined with another opioid. Finally, 60.6% were not combined with a laxative.

The majority of patients treated with oxycodone in surgery had inappropriate prescribing. Considering the known risk of developing opioid use disorder after a first administration in surgery, important educational effort seems needed.