Pre-emptive Oxycodone versus Sufentanil for Acute and Delayed Pain after Transcatheter Arterial Chemoembolization: A...

To compare the effectiveness of pre-emptive oxycodone versus sufentanil for acute and delayed pain control after transcatheter arterial chemoembolization (TACE).

In this prospective, double-blind trial, 40 patients scheduled for TACE were randomized to receive intravenous oxycodone (0.1 mg/kg) or sufentanil (0.1 μg/kg) 15 minutes before TACE. Pain intensity was assessed using a visual analog scale (VAS) during acute (0-24 hours) and delayed (Days 2-7) phases. Inflammatory biomarkers (white blood cell count, neutrophil percentage, C-reactive protein, and interleukin [IL]-6) were measured at baseline and 24 hours after TACE. The primary outcome was the highest acute-phase VAS scores; secondary outcomes included delayed-phase pain, changes in inflammatory biomarkers, and adverse events.

Oxycodone demonstrated superior analgesia, with lower intraprocedural VAS scores (median, 0 [interquartile range {IQR}, 0-1.0] vs 3.5 [IQR, 1.3-4.8]; P < .001) and reduced incidence of moderate-to-severe pain (5% vs 50%; P = .003). This benefit persisted at 1-6 hours after TACE (median, 0 [IQR, 0-1.0] vs 2 [IQR, 0-3.0]; P = .042). During the delayed phase, oxycodone maintained lower pain scores (median, 0 [IQR, 0-0] vs 0 [IQR, 0-3.8]; P = .042) and fewer episodes of moderate pain (0% vs 25%; P = .047). IL-6 elevation was greater in patients developing delayed pain (671.16% vs 135.97% increase; P = .030). Adverse event rates were comparable.

Pre-emptive oxycodone provided more effective acute and delayed pain control after TACE compared with sufentanil, with comparable safety. The association between IL-6 elevation and delayed pain suggests an inflammatory pain component, supporting further investigation of combined opioid and anti-inflammatory strategies.