Oxycodone versus Sufentanil for Postoperative Analgesia and Early Recovery After Radical Gastrectomy: A Propensity...

Radical gastrectomy is associated with trauma and severe pain. We examined whether oxycodone could improve postoperative analgesia and early recovery compared with sufentanil in patients undergoing radical gastrectomy.

Patients who underwent radical gastrectomy with patient-controlled intravenous analgesia (PCIA) based on sufentanil or oxycodone for postoperative pain management from January 2022 to December 2023 were included in this study. We used a 1:1 ratio propensity score matching (PSM) in our study to adjust for confounding factors and differences between groups. Patient demographics, surgical and anesthesia details, analgesic effects, and recovery profiles were recorded and analyzed.

After PSM, 224 patients were included in each group. Oxycodone treatment was associated with improved pain scores at rest and during movement at 2 h postoperatively (P<0.001), fewer rescue analgesics (P=0.005), shorter time to first flatus and defecation (P=0.030; P=0.016), reduced indwelling nasogastric tube time (P=0.043), shorter length of hospital stay (P=0.031), and lower incidence of nausea in the matched cohort (P=0.049). There were significantly higher lymphocytes (POD1 and POD3: all P<0.001), CD4⁺ T cells (POD1: P=0.003; POD3: P<0.001) and CD4⁺/CD8⁺ T cell ratio (POD1 and POD3: all P<0.001), and lower CD8⁺ T cells (POD1: P=0.001; POD3: P<0.001). Subgroup analysis stratified by age, surgical technique, and resection extent demonstrated no significant interaction effects across all variables (P-interaction > 0.05).

Compared with sufentanil, oxycodone-based PCIA was associated with lower early postoperative pain scores, reduced immune suppression and fewer adverse reactions, and faster gastrointestinal function recovery.