Abstract

A randomized trial to compare pain control using oral analgesia with epidural analgesia after cesarean section following combined spinal-epidural anesthesia

This study aimed to evaluate whether combined oral oxycodone hydrochloride-controlled release tablets plus paracetamol and tramadol hydrochloride tablets are more effective than epidural analgesia for postoperative pain control and side effects after cesarean section. We randomly enrolled 60 patients scheduled for cesarean section into either: patient-controlled epidural analgesia with 0.1% ropivacaine + 0.1 μg/mL sufentanil (for postoperative 48 h) + injected pethidine on demand (E group); or controlled-release oxycodone (2 x 15 mg for the first postoperative 24 h; 2 x 10 mg for the second postoperative 24 h) + paracetamol and tramadol hydrochloride tablets (8 x 1 tablet for the postoperative 48 h) orally + injected pethidine on demand (O group). The E group experienced more evoked pain and uterine cramping pain at all times postoperatively. The patients who received oral analgesia had less resting pain at 6, 12, 24, and 36 h after surgery. Two patients in the E group injected pethidine (150 mg total) during the oxytocin infusion, whereas none of the O group patients injected pethidine. Pruritus was more common in the E group (P < 0.05). Maternal satisfaction with the analgesia regimen was lower in the E group (P < 0.01). The median duration of hospital stay was about 5 days for both groups. Postoperative pain control after cesarean section with oral oxycodone hydrochloride-controlled release tablets plus paracetamol and tramadol hydrochloride tablets is preferable to epidural analgesia, even when side effects and maternal satisfaction are taken into account.

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