Minireviews Open Access
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 6, 2022; 10(16): 5156-5164
Published online Jun 6, 2022. doi: 10.12998/wjcc.v10.i16.5156
Advances in the clinical application of oxycodone in the perioperative period
Hong-Yang Chen, Wei-Yi Zhang, Tao Zhu, Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Hong-Yang Chen, Wei-Yi Zhang, Tao Zhu, The Research Units of West China(2018RU012)-Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Zi-Ning Wang, Department of Anesthesiology, West China School of Clinical Medicine, Sichuan University, Chengdu 610041, Sichuan Province, China
ORCID number: Hong-Yang Chen (0000-0003-0919-8554); Zi-Ning Wang (0000-0002-0472-8854); Wei-Yi Zhang (0000-0002-9840-4614); Tao Zhu (0000-0001-6839-0134).
Author contributions: Chen HY searched and sorted out the literature, and drafted the manuscript; Wang ZN took responsibility for data curation; Zhu T and Zhang WY revised the manuscript; all authors read and approved the final manuscript.
Supported by The National Key Research and Development Program, No. 2020YFC2005303.
Conflict-of-interest statement: All authors declare that they have no conflicts of interest to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei-Yi Zhang, MD, Associate Chief Physician, Department of Anesthesiology, West China Hospital, Sichuan University, No. 37 Guoxue Street, Chengdu 610041, Sichuan Province, China. zhangweiyi@wchscu.cn
Received: December 22, 2021
Peer-review started: December 22, 2021
First decision: January 25, 2022
Revised: January 29, 2022
Accepted: April 4, 2022
Article in press: April 4, 2022
Published online: June 6, 2022
Processing time: 161 Days and 21.4 Hours

Abstract

To review the research progress of pure opioid receptor agonist oxycodone. The research progress of oxycodone in terms of pharmacokinetics, pharmacodynamics, adverse reactions, clinical application, combined medication and new progress in clinical application was summarized by referring to the literature. Oxycodone is a semi-synthetic thebaine derivative of opioid alkaloids, and is a pure opioid μ and κ receptor agonist. The main action sites are the central nervous system and visceral smooth muscle. Due to its advantages of low adverse reactions, good analgesic effects, and a wide range of safe doses, the drug has been widely used in the control of acute and chronic postoperative pain, as well as malignant and non-malignant pain. Since the end of the 20th century, researchers have begun to formulate antipyretic analgesics, opioid receptor agonists, opioid receptor antagonists, dopamine receptor antagonists and other drugs with oxycodone in different proportions to enhance the analgesic effect. At the same time, it can reduce the dosage of oxycodone and reduce its adverse reactions, so as to achieve the purpose of limiting opioid abuse. With the continuous research on the efficacy and safety of oxycodone in the perioperative period at home and abroad, oxycodone has become the only dual-opioid potent analgesic that can be used in clinical work.

Key Words: Oxycodone; Anesthesia; Acute pain; Clinical application; Pharmacodynamics

Core Tip: Oxycodone is a semi-synthetic opioid extracted from a plant derivative of tiabaine and gradually applied in clinical practice. It is an opioid μ and κ receptor agonist, a class of potent opioid analgesics. It mainly acts on smooth muscle by agonizing κ receptors to relieve visceral neuralgia; on the other hand, it can act on the central nervous system by agonizing μ receptors to produce analgesic effects.



INTRODUCTION

Pain is defined by the medical community as the fifth vital sign after respiration, pulse, temperature and blood pressure. It is an unpleasant emotional experience and is accompanied by tissue damage as a reflex mechanism for self-protection, and is also a common reaction after surgery. Postoperative pain is mostly a strong acute pain, which not only causes physical discomfort and psychological trauma to patients, but also leads to changes in their endocrine system, causing pulmonary and other complications, thus affecting incision healing and postoperative recovery, and prolonging hospitalization. If this acute pain is poorly controlled, it is often transformed into chronic pain due to psychospiritual changes, peripheral and central sensitization of the patient.

Therefore, to reduce postoperative pain, postoperative complications and the incidence of postoperative stress, adequate postoperative analgesia is required to shorten the recovery period and observation period of patients after surgery and to facilitate early discharge[1]. A wide range of analgesic drugs are currently used in clinical practice, including pure opioid agonists such as morphine, fentanyl, and remifentanil, partial opioid agonist antagonists such as bupropion and dizocine, weak opioid agonists such as tramadol, and non-opioid drugs such as non-steroidal anti-inflammatory drugs, acetaminophen, local anesthetics, glucocorticoids, NMDA receptor antagonists, α2 agonists, etc. As a potent opioid, oxycodone is a drug with good analgesic effects and is mainly used not only for the treatment of cancer pain and acute and chronic non-cancer pain, but also for the treatment of moderate to severe acute pain, including moderate to severe pain caused by post-surgery. It has replaced morphine as the first-line postoperative analgesic drug in many countries because of its advantages such as low adverse effects, good analgesic effects and a wide range of safe doses[2].

Oxycodone is a semi-synthetic opioid extracted from a plant derivative of tiabaine and gradually applied in clinical practice. It is an opioid μ and κ receptor agonist, which is a class of potent opioid analgesics. It mainly acts on smooth muscle by agonizing κ receptors to relieve visceral neuralgia; on the other hand, it can act on the central nervous system by agonizing μ receptors to produce analgesic effects.

PHARMACODYNAMICS

Pöyhiä et al[3] compared the analgesic effects of different routes of administration of oxycodone and morphine by the heat radiation tail-shaking method and the hot plate method in rats. Subcutaneous (5 mg/kg) and intraperitoneal (2.5 mg/kg) administration of oxycodone was two to four times more potent than morphine. The onset of analgesia of subcutaneous and intraperitoneal (2.5-5 mg/kg) oxycodone is faster (15-30 min) than that of subcutaneous and intraperitoneal (5-10 mg/kg) morphine, the onset of action is the same at high doses (15 min), and the duration of analgesia of subcutaneous oxycodone and morphine is similar, with no significant difference. Staahl et al[4] compared the analgesic effects of oxycodone and morphine on pain produced by mechanical, thermal and electrical stimuli in healthy subjects. Subjects were given morphine (30 mg), oxycodone (15 mg), and placebo, and the analgesic effects of morphine versus oxycodone were examined by mechanical, thermal, and electrical stimulation of pain after 30 min of oral administration. The results showed that morphine and oxycodone had analgesic effects on pain produced by the three types of stimuli, but the analgesic effects of oxycodone on pain produced by mechanical and thermal stimuli were better than those of morphine.

PHARMACOKINETICS

Oxycodone is a weak base with a drug dissociation constant of 8.5. Its lipid solubility is mainly bound to serum proteins, similar to morphine, but both have lower lipid solubility than fentanyl[5]. Oxycodone is currently available as controlled and sustained-release tablets, injectables, and suppositories, and is administered orally, subcutaneously and intravenously, as well as rectally, epidurally, and intranasally[6]. Oxycodone is well absorbed orally and is 3-4 times more bioavailable than morphine[7]. Olkkola et al[7] found that intravenous oxycodone has a rapid onset of action and can rapidly achieve blood-brain homeostasis. Clinical data show that when oxycodone is administered intravenously, its analgesic effect is comparable to or 1.5 times greater than that of morphine[8].

Oxycodone is mainly metabolized by the liver in the body, and its metabolic pathway is mainly through O-position demethylation catalyzed by CYP2D6 subtypes to form active oxymorphone, and then through CYP3A4N demethylation to inactive norethindrone; another pathway is N-position demethylation catalyzed by CYP3A4 and CYP3A5 subtypes of hepatic P450 to inactive norethindrone. The other pathway is that the N position demethylation is catalyzed by two subtypes of hepatic P450, CYP3A4 and CYP3A5, to the inactive noroxycodone, which is then metabolized by CYP2D6 to the inactive hydromorphone. The concentrations of noroxycodone in plasma and urine were significantly higher after oral administration than after intramuscular injection, suggesting that oxycodone is metabolized mainly by demethylation in the first-pass effect. The oxycodone metabolite oxymorphone is mainly excreted in the bound state, norethindrone is mainly excreted in the free form, and some free oxycodone is excreted in the urine[9].

ADVERSE REACTIONS

Oxycodone, one of the opioid analgesics, has adverse effects common to other opioids, such as dry mouth, constipation, nausea, vomiting, pruritus, dizziness, drowsiness, and confusion[10]. The literature reports that oxycodone has the risk of causing dependence and drug abuse, and its psychiatric dependence is associated with increased release of striatal dopamine, but the risk is much less than other μ opioid agonists and does not cause side effects such as psychotic euphoria and respiratory depression[11]. Strong opioids such as morphine and fentanyl reduce T cells and have immunosuppressive effects, but oxycodone has weaker immunosuppressive effects than morphine.

Oxycodone overdose can lead to drowsiness, coma, pupil constriction, muscle relaxation, seizures, bradycardia, respiratory depression, and hypotonia[12]. Detoxification should be performed with intravenous naloxone, repeated intravenous pushes or continuous intravenous drips to prevent fatal poisoning[13]. Cardiopulmonary resuscitation should be given immediately in the presence of cardiogenic shock due to severe oxycodone overdose[14-17]. The studies by Warner et al and Ahmedzai et al[18] showed that Oxycodone reduced opioid-induced constipation in chronic pain management, which not only prevented gastrointestinal adverse effects, but also had little effect on analgesic efficacy[19].

CLINICAL APPLICATIONS

Prophylactic analgesia is a form of analgesia that blocks the transmission, conduction, and establishment of peripheral injurious impulses to the center and reduces the peripheral and central sensitization caused by noxious stimulus afferents[20]. As a long-acting, non-accumulative opioid, oxycodone can provide suitable prophylactic analgesia. As the only dual agonist of μ and κ receptors in clinical practice, oxycodone has been occupying an extremely important position in postoperative analgesia and cancer pain control[21].

ACUTE PAIN

Studies have shown that oxycodone reaches stable concentrations in the brain more quickly than morphine, making it superior to morphine for rapid analgesia. The release of histamine in the body is significantly less with oxycodone analgesia than with morphine. In a review of oral oxycodone analgesia, it was demonstrated that oral oxycodone was effective for acute postoperative pain control and that the analgesic strength of oxycodone was two to three times that of codeine; in addition, the analgesic effect of oxycodone was enhanced by combining it with acetaminophen[22]. Subsequently, the authors reviewed single-dose oral oxycodone in combination with ibuprofen and came to a similar conclusion: The combination of oxycodone prolongs the duration of analgesia and reduces the incidence of adverse effects[23].

Oxycodone is used for postoperative analgesia and has a lower incidence of nausea and easier termination of analgesia when given orally compared to intravenous self-administered pumps[24]. Evidence suggests that epidural administration of oxycodone is not superior to intravenous administration[25], and the dosage of oxycodone is approximately 10 times that of morphine for the same analgesic effect, consistent with preclinical studies[25,26]. In a randomized controlled study comparing the analgesic effect of oral oxycodone with intrathecal morphine after cesarean delivery, the analgesic effect was similar and the incidence of pruritus was lower in the oxycodone group[27]. In acute pain control, the analgesic effect of oxycodone may be related to the route of administration.

CHRONIC PAIN

Although opioids are spreading rapidly in the management of chronic non- cancer pain. However, it is not the first-line treatment for chronic noncancer pain, nor is it recommended to treat chronic noncancer pain with opioids alone. Although some chronic pain can be relieved with strong opioid therapy, such as osteoarthritic pain, intervertebral disc disease, diabetic polyneuropathy, and postherpetic neuralgia. However, the need for continued use of opioids for non- cancer pain needs to be evaluated periodically. Therefore, when patients no longer require treatment with oxycodone, the dose of the drug should be gradually reduced to prevent withdrawal symptoms[28,29].

VISCERAL NEURALGIA PAIN

Visceral pain is caused by mechanical stretching, spasm, inflammation, and surgical stimulation and is the result of sensory afferent nerve stimulation of visceral organ activity, and receptors on the walls of cavernous organs are sensitive to stretching and distending stimuli. Oxycodone can agonize κ-opioid receptors, which are involved in the modulation of visceral pain; therefore, oxycodone is more effective in visceral pain[30]. One study again compared the analgesic effect of oxycodone with morphine by inducing nociceptive sensitization in humans, and the analgesia was superior to morphine in different experimental pain models[31]. Although the effect of oxycodone on visceral pain is controversial, Lenz et al[32] compared the analgesic effect of oxycodone and morphine when used in patients with self-administered pumps and showed that the total consumption of oxycodone was less than morphine and that the analgesic effect was superior to morphine in the first postoperative hour.

CANCER PAIN

The quality of life of cancer patients in the late stage of cancer often depends on the degree of cancer pain, and the quality of life of patients with cancer pain is very poor. Oxycodone also has a good effect in controlling cancer pain. Compared to morphine, oxycodone may have a lower incidence of nausea and hallucinations. Oral morphine, oxycodone, and hydromorphone have been reported to produce similar efficacy as well as toxic effects in patients with cancer pain[33]. Constipation is the most common and difficult to control adverse effects when using opioids to control cancer pain[18,34]. Combination with naloxone may improve this condition. Therefore, for the treatment of advanced cancer, the best drug choice is currently oxycodone to improve the quality of survival and reduce patients' pain.

COMBINATION MEDICATION
Oxycodone grouped with antipyretic and analgesic

Pain is mostly caused by the release of a large number of inflammatory mediators from the damaged area stimulating nerve endings to form excitatory transmission, which is integrated via the spinal reticular upward transmission system to the central brain to produce a nociceptive response.

Antipyretic and analgesic drugs are mainly used in the periphery to inhibit cyclooxygenase activity, reduce prostaglandin production and release of inflammatory substances (e.g. cytokines interleukin 1 (lL-1), lL-6 and lL-8, substance P, bradykinin, nerve growth factor, etc.) to produce anti-inflammatory and analgesic effects. Oxycodone is a central analgesic, that mainly inhibits the transmission and integration of nociceptive information to achieve analgesic effects. The combination of antipyretic and analgesic drugs with oxycodone not only complements the mechanism of action and improves analgesic efficacy, but also reduces the dose of oxycodone alone and reduces adverse effects such as oxycodone tolerance and addiction. Several clinical studies have confirmed that this compound has been widely used for clinical analgesia, including rheumatoid arthritis, osteoarthritis pain in elderly women, chronic non-cancer pain, cancer pain, post-surgical pain, chronic skeletal muscle sarcoid pain and neuropathic pain of various moderate to severe pain, all of which have shown good analgesic effects[22,35,36].

In addition, it also has clear analgesic effects in postoperative pain such as orthopedic surgery, dental surgery, and abdominal or pelvic surgery. The analgesic strength is better than that of each single drug (such as Aspirin, Acetaminophen, Indomethacin, Meloxicam, Ibuprofen and Diclofenac), the onset of action is faster (15 min after administration), and the effective duration of analgesia is significantly longer than that of any of the single drugs.

Oxycodone grouped with opioid receptor antagonists

Because oxycodone is an opioid agonist, it has the same adverse effects as other opioids, the most common of which are effects on bowel function. Opioids increase intestinal smooth muscle tone and decrease its propulsion, increase fluid absorption and inhibit its secretion, thus inducing intestinal dysfunction, leading to gas, difficult bowel movements and constipation (called opioid- induced constipation (OlC)[37,38].

More seriously, long-term use of opioid agonists can induce nociceptive hypersensitivity and drug dependence, severely limiting the scope of use of this class of drugs. In recent years, it has been found that chronic opioid treatment induces a shift from Gi/Gs to Gs in μ-opioid receptor (MOR)-coupled G proteins, and thus the effect of opioid agonists changes from initial inhibition to excitation, causing enhanced excitatory synaptic transmission in the spinal cord, a change that can lead to nociceptive hypersensitivity, while this response is also involved in opioid-induced tolerance and dependence. This change leads to the development of nociceptive hyperalgesia, and this response is also involved in the development of opioid-induced tolerance and dependence[39]. Concomitant administration of an ultra-low dose of an opioid receptor antagonist (naloxone or naltrexone) with opioids not only reduces the shift from inhibition to excitation induced by chronic agonist processing, but also reduces the formation of dependence.

Therefore, therapeutic doses of oxycodone have been made into oral tablets with ultra-low doses of antagonists in an attempt to reduce their adverse effects without compromising their analgesic effects[40]. Several clinical studies have shown that compounding has the same analgesic effect compared to oxycodone alone, but significantly improves OlC, with other adverse effects less than or comparable to those of the single agent. After 4 weeks of compounding in patients with chronic neuropathic pain, 1488 patients showed a significant reduction in pain intensity, a return to normal bowel function, and a significant improvement in quality of life (47%)[41,42].

Oxycodone and Morphine formulation

The results of numerous studies in animals and humans suggest that when opioids acting on different opioid receptor subtypes are combined, it is possible to enhance their analgesic effects and attenuate adverse effects. The analgesic effect of morphine is mainly mediated by μ1-receptors, and the analgesic effect of oxycodone is mainly mediated by μ1 and κ-receptors. In the absence of morphine, oxycodone activates κ receptors to produce analgesic effects; in the presence of morphine, oxycodone activates κ-receptors to produce satisfactory analgesic effects, and at the same time antagonizes morphine μ2-receptor-like effects, reducing or eliminate side effects such as respiratory depression. Therefore, in recent years, some studies have combined morphine with oxycodone and found that the analgesic effects of the two drugs have a significant synergistic effect in a large number of animal and human studies, and the adverse effects are significantly reduced[43,44].

The analgesic efficacy of morphine/oxycodone combination on postoperative pain was compared in a clinical randomized, double-blind, multicenter, parallel-controlled study abroad. The results showed that the analgesic effect of morphine in combination with an oxycodone controlled-release formulation was also significantly enhanced in patients with cancer pain, and patient subjective satisfaction and quality of life were significantly improved. Adverse effects such as nausea, vomiting, sedation and respiratory depression were significantly reduced compared with the two single-drug groups[45]. Therefore, the morphine/oxycodone combination can be used as the drug of choice for moderate to severe pain.

Oxycodone grouped with dopamine receptor antagonists

ROTUNDINE is a dopamine (DA) 2 receptor antagonist. The involvement of the central DA nervous system in nociceptive modulation has been extensively investigated, focusing on the function and interaction of endogenous opioid peptides and monoamine neurotransmitters in the spinal cord and brainstem nociceptive downstream regulatory systems, and in particular on the important role of the DA nervous system in the formation of opioid-induced psychiatric dependence. Current research suggests that all natural or non-natural rewarding stimuli produce "euphoria" by activating the limbic DA reward system in the midbrain, and that the DA and opioid systems are two important components of the reward mechanism[46,47]. Studies have shown that the combination of oxycodone and rotenone not only significantly increases the analgesic effect of oxycodone, but also decreases the dosage of oxycodone and reduces its tolerance rate and dependence potential.

Oxycodone compounded with other drugs

The prevalence of neuropathic pain is very high both nationally and internationally. Studies have shown that the combination of oxycodone and gabapentin significantly relieved neuropathic pain, and the combination of the two drugs was significantly better than gabapentin alone in terms of pain relief, withdrawal ratio, and improvement in sleep quality, while oxycodone-induced adverse effects were not exacerbated by the combination of the two drugs[48]. Zacny et al[49] found that pregabalin was able to dose-dependently increase certain subjective effects in healthy volunteers that decreased respiratory rate, but did not affect psychomotor behavior in volunteers, nor subjective behaviors related to abuse propensity such as drug addiction and craving behavior; oxycodone alone was able to increase a variety of subjective behaviors, including rates of drug addiction; however, pregabalin did not affect the effects of oxycodone; these results suggest that the combination of pregabalin and oxycodone does not increase the addictive potential of oxycodone. Therefore, it is possible to use the two-drug combination for the treatment of neuropathic pain in the future.

NEW ADVANCES IN CLINICAL APPLICATIONS

Fentanyl is a commonly used opioid with rapid onset, short duration, and relatively stable hemodynamics. Although there may be some adverse effects, such as hypotension, chest wall stiffness, respiratory depression, and postoperative nausea, it is still used clinically for the induction and maintenance of general anesthesia because it can block the afferent impulse from pharyngeal stimulation during intubation and reduce the cardiovascular response during intubation[50]. The induction dose used in non-cardiac surgery is 2-4 μg/kg. Oxycodone is administered intravenously, with an onset of action of 2-3 min and a peak blood concentration of 5 min. And the maintenance time is approximately 4 h[51]. The equivalent dose conversion between fentanyl and oxycodone is 1:100[52], so the choice of oxycodone is 0.2 mg/kg. Some literature reports[53], that fentanyl doses greater than 5 μg/kg to completely block the sympathetic nervous response induced by tracheal intubation.

Studies on exploring the effectiveness and safety of oxycodone for general anesthesia tracheal intubation have shown that oxycodone has less effect on blood pressure and heart rate than fentanyl and has a relatively smooth circulation[52,54-56]. Another issue to consider with oxycodone as an induction drug is its effect on anesthetic awakening and extubation. This study showed no significant difference between oxycodone and fentanyl at the time of awakening and extubation for procedures within 4 h.

In addition, the use of oxycodone for the induction of general anesthesia can also prevent some common adverse complications and improve patient comfort to a large extent while ensuring the safety of anesthesia. (1) Oxycodone can prevent fentanyl-induced cough (FIC), and its mechanism of action is related to the direct action of oxycodone on the cough center of the medulla oblongata. The mechanism of action is related to the direct action of oxycodone on the cough center of the medulla oblongata, which produces cough suppression[52]. In addition, oxycodone can reduce the dosage of fentanyl drugs, thus reducing their blood concentration, which also reduces the occurrence of FIC to a certain extent; (2) Oxycodone can effectively improve the adverse complications of rocuronium bromide and propofol injection pain, and its mechanism of action may be related to the agonization of opioid receptors in the central nervous system, but there is no conclusive evidence yet[57,58]; and (3) some studies have shown that oxycodone given intravenously at 0.1 mg/kg before etomidate induction has a better effect on the prevention of myoclonus and a lower incidence of respiratory depression than fentanyl at 1 μg/kg, and the ED50 (median effective dose) of oxycodone inhibition of etomidate-induced myoclonus is higher in middle- aged patients than in older patients[58,59], but the mechanism of its occurrence needs to be further studied.

Therefore, more refined research and exploration of whether oxycodone can be safely and effectively used for the induction of general anesthesia and whether it can be used to maintain anesthesia in the book remain to be done in the future.

COMMENT

As the only double opioid potent analgesic available in clinical practice, oxycodone has the following advantages: first, the central analgesic effect of the original drug is dominant, the metabolites are almost inactive, only oxymorphinone is active, but its content is extremely low. Second, intravenous administration has a rapid onset of action, and it is easy to achieve stable blood concentrations, which can provide rapid pain relief. Third, the bioavailability of different routes of administration is high, which facilitates the transition from intravenous to oral administration in postoperative patients.

However, it must be admitted that it has the common adverse effects of opioids. Although there are some foreign studies on the efficacy and safety of oxycodone in the perioperative period, it is important not to copy foreign experiences due to the differences in ethnicity, medical system and environment. We need to re-evaluate the perioperative safety and efficacy of oxycodone through more clinical studies to explore the effective dose and safe dose, the incidence and severity of related adverse reactions, and the principles of treatment that are suitable for the national population.

CONCLUSION

Oxycodone is a semi-synthetic thebaine derivative of opioid alkaloids, and is a pure opioid μ and κ receptor agonist. The main action sites are the central nervous system and visceral smooth muscle. Due to its advantages of low adverse reactions, good analgesic effects, and a wide range of safe doses, the drug has been widely used in the control of acute and chronic postoperative pain, as well as malignant and non-malignant pain. Since the end of the 20th century, researchers have begun to formulate antipyretic analgesics, opioid receptor agonists, opioid receptor antagonists, dopamine receptor antagonists and other drugs with oxycodone in different proportions to enhance the analgesic effect. At the same time, it can reduce the dosage of oxycodone and reduce its adverse reactions, so as to achieve the purpose of limiting opioid abuse. With the continuous research on the efficacy and safety of oxycodone in the perioperative period at home and abroad, oxycodone has become the only dual-opioid potent analgesic that can be used in clinical work.

Footnotes

Provenance and peer review: Unsolicited article; Externally peer reviewed.

Peer-review model: Single blind

Specialty type: Anesthesiology

Country/Territory of origin: China

Peer-review report’s scientific quality classification

Grade A (Excellent): 0

Grade B (Very good): 0

Grade C (Good): C

Grade D (Fair): D

Grade E (Poor): 0

P-Reviewer: Aurilio C, Italy; Mark EB, Denmark S-Editor: Liu JH L-Editor: A P-Editor: Liu JH

References
1.  Wu CL, Raja SN. Treatment of acute postoperative pain. Lancet. 2011;377:2215-2225.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 364]  [Cited by in F6Publishing: 353]  [Article Influence: 27.2]  [Reference Citation Analysis (0)]
2.  Kokki M, Broms S, Eskelinen M, Rasanen I, Ojanperä I, Kokki H. Analgesic concentrations of oxycodone--a prospective clinical PK/PD study in patients with laparoscopic cholecystectomy. Basic Clin Pharmacol Toxicol. 2012;110:469-475.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 34]  [Cited by in F6Publishing: 39]  [Article Influence: 3.0]  [Reference Citation Analysis (0)]
3.  Pöyhiä R, Kalso EA. Antinociceptive effects and central nervous system depression caused by oxycodone and morphine in rats. Pharmacol Toxicol. 1992;70:125-130.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 61]  [Cited by in F6Publishing: 62]  [Article Influence: 1.9]  [Reference Citation Analysis (0)]
4.  Staahl C, Christrup LL, Andersen SD, Arendt-Nielsen L, Drewes AM. A comparative study of oxycodone and morphine in a multi-modal, tissue-differentiated experimental pain model. Pain. 2006;123:28-36.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 118]  [Cited by in F6Publishing: 125]  [Article Influence: 6.9]  [Reference Citation Analysis (0)]
5.  Wang JJ, Sung KC, Yeh CH, Fang JY. The delivery and antinociceptive effects of morphine and its ester prodrugs from lipid emulsions. Int J Pharm. 2008;353:95-104.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 21]  [Cited by in F6Publishing: 22]  [Article Influence: 1.4]  [Reference Citation Analysis (0)]
6.  Yoshimoto T, Ryu E, Tomiyasu S, Hojo M, Kokubun H, Matoba M. Efficacy and Safety of Oxycodone Injection for Relieving Cancer Pain: A Study in Japan Consisting of Two Open Trials for Intravenous and Subcutaneous Administration. Biol Pharm Bull. 2018;41:850-857.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 4]  [Cited by in F6Publishing: 5]  [Article Influence: 0.8]  [Reference Citation Analysis (0)]
7.  Olkkola KT, Kontinen VK, Saari TI, Kalso EA. Does the pharmacology of oxycodone justify its increasing use as an analgesic? Trends Pharmacol Sci. 2013;34:206-214.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 48]  [Cited by in F6Publishing: 50]  [Article Influence: 4.5]  [Reference Citation Analysis (0)]
8.  McNicol E, Horowicz-Mehler N, Fisk RA, Bennett K, Gialeli-Goudas M, Chew PW, Lau J, Carr D; Americal Pain Society. Management of opioid side effects in cancer-related and chronic noncancer pain: a systematic review. J Pain. 2003;4:231-256.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 303]  [Cited by in F6Publishing: 298]  [Article Influence: 14.2]  [Reference Citation Analysis (0)]
9.  Raleigh MD, Accetturo C, Pravetoni M. Combining a Candidate Vaccine for Opioid Use Disorders with Extended-Release Naltrexone Increases Protection against Oxycodone-Induced Behavioral Effects and Toxicity. J Pharmacol Exp Ther. 2020;374:392-403.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 4]  [Cited by in F6Publishing: 9]  [Article Influence: 2.3]  [Reference Citation Analysis (0)]
10.  Sproule B, Brands B, Li S, Catz-Biro L. Changing patterns in opioid addiction: characterizing users of oxycodone and other opioids. Can Fam Physician. 2009;55:68-69, 69.e1.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 1]  [Cited by in F6Publishing: 1]  [Article Influence: 0.3]  [Reference Citation Analysis (0)]
11.  Dahmke H, Kupferschmidt H, Kullak-Ublick GA, Weiler S. [Nalmefene and Opioid Withdrawal Syndrome: Analysis of the Global Pharmacovigilance Database for Adverse Drug Reactions]. Praxis (Bern 1994). 2015;104:1129-1134.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 5]  [Cited by in F6Publishing: 4]  [Article Influence: 0.4]  [Reference Citation Analysis (0)]
12.  Paljarvi T, Strang J, Quinn PD, Luciano S, Fazel S. Abuse-deterrent extended-release oxycodone and risk of opioid-related harm. Addiction. 2021;116:2409-2415.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 4]  [Cited by in F6Publishing: 4]  [Article Influence: 1.3]  [Reference Citation Analysis (0)]
13.  Meissner W, Leyendecker P, Mueller-Lissner S, Nadstawek J, Hopp M, Ruckes C, Wirz S, Fleischer W, Reimer K. A randomised controlled trial with prolonged-release oral oxycodone and naloxone to prevent and reverse opioid-induced constipation. Eur J Pain. 2009;13:56-64.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 180]  [Cited by in F6Publishing: 161]  [Article Influence: 10.1]  [Reference Citation Analysis (0)]
14.  Hedegaard H, Bastian BA, Trinidad JP, Spencer MR, Warner M. Regional Differences in the Drugs Most Frequently Involved in Drug Overdose Deaths: United States, 2017. Natl Vital Stat Rep. 2019;68:1-16.  [PubMed]  [DOI]  [Cited in This Article: ]
15.  Spencer MR, Warner M, Bastian BA, Trinidad JP, Hedegaard H. Drug Overdose Deaths Involving Fentanyl, 2011-2016. Natl Vital Stat Rep. 2019;68:1-19.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 1]  [Cited by in F6Publishing: 1]  [Article Influence: 0.2]  [Reference Citation Analysis (0)]
16.  Hedegaard H, Bastian BA, Trinidad JP, Spencer M, Warner M. Drugs Most Frequently Involved in Drug Overdose Deaths: United States, 2011-2016. Natl Vital Stat Rep. 2018;67:1-14.  [PubMed]  [DOI]  [Cited in This Article: ]
17.  Warner M, Trinidad JP, Bastian BA, Minino AM, Hedegaard H. Drugs Most Frequently Involved in Drug Overdose Deaths: United States, 2010-2014. Natl Vital Stat Rep. 2016;65:1-15.  [PubMed]  [DOI]  [Cited in This Article: ]
18.  Ahmedzai SH, Nauck F, Bar-Sela G, Bosse B, Leyendecker P, Hopp M. A randomized, double-blind, active-controlled, double-dummy, parallel-group study to determine the safety and efficacy of oxycodone/naloxone prolonged-release tablets in patients with moderate/severe, chronic cancer pain. Palliat Med. 2012;26:50-60.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 122]  [Cited by in F6Publishing: 116]  [Article Influence: 9.7]  [Reference Citation Analysis (0)]
19.  Nadstawek J, Leyendecker P, Hopp M, Ruckes C, Wirz S, Fleischer W, Reimer K. Patient assessment of a novel therapeutic approach for the treatment of severe, chronic pain. Int J Clin Pract. 2008;62:1159-1167.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 43]  [Cited by in F6Publishing: 46]  [Article Influence: 2.9]  [Reference Citation Analysis (0)]
20.  Wu YX, Chen H, Zhou JX. Short-term use of remifentanil during endotracheal extubation for prophylactic analgesia in neurosurgical patients after craniotomy (SURE after Craniotomy Study): a study protocol and statistical analysis plan for a randomised controlled trial. BMJ Open. 2014;4:e005635.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 4]  [Cited by in F6Publishing: 5]  [Article Influence: 0.5]  [Reference Citation Analysis (0)]
21.  Schmidt-Hansen M, Bennett MI, Arnold S, Bromham N, Hilgart JS. Efficacy, tolerability and acceptability of oxycodone for cancer-related pain in adults: an updated Cochrane systematic review. BMJ Support Palliat Care. 2018;8:117-128.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 11]  [Cited by in F6Publishing: 13]  [Article Influence: 2.2]  [Reference Citation Analysis (0)]
22.  Gaskell H, Derry S, Moore RA, McQuay HJ. Single dose oral oxycodone and oxycodone plus paracetamol (acetaminophen) for acute postoperative pain in adults. Cochrane Database Syst Rev. 2009;CD002763.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 49]  [Cited by in F6Publishing: 63]  [Article Influence: 4.2]  [Reference Citation Analysis (0)]
23.  Derry S, Karlin SM, Moore RA. Single dose oral ibuprofen plus codeine for acute postoperative pain in adults. Cochrane Database Syst Rev. 2013;CD010107.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 60]  [Cited by in F6Publishing: 57]  [Article Influence: 5.2]  [Reference Citation Analysis (0)]
24.  Rothwell MP, Pearson D, Hunter JD, Mitchell PA, Graham-Woollard T, Goodwin L, Dunn G. Oral oxycodone offers equivalent analgesia to intravenous patient-controlled analgesia after total hip replacement: a randomized, single-centre, non-blinded, non-inferiority study. Br J Anaesth. 2011;106:865-872.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 36]  [Cited by in F6Publishing: 36]  [Article Influence: 2.8]  [Reference Citation Analysis (0)]
25.  Scardino M, Grappiolo G, Gurgone A, Mazziotta G, Astore F, Ferrari M. Single-shot epidural-spinal anesthesia followed by oral oxycodone/naloxone and ketoprofen combination in patients undergoing total hip replacement: analgesic efficacy and tolerability. Minerva Anestesiol. 2015;81:19-27.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 1]  [Cited by in F6Publishing: 1]  [Article Influence: 0.1]  [Reference Citation Analysis (0)]
26.  Lemberg KK, Kontinen VK, Siiskonen AO, Viljakka KM, Yli-Kauhaluoma JT, Korpi ER, Kalso EA. Antinociception by spinal and systemic oxycodone: why does the route make a difference? in vivo105:801-812.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 67]  [Cited by in F6Publishing: 69]  [Article Influence: 3.8]  [Reference Citation Analysis (0)]
27.  McDonnell NJ, Paech MJ, Browning RM, Nathan EA. A randomised comparison of regular oral oxycodone and intrathecal morphine for post-caesarean analgesia. Int J Obstet Anesth. 2010;19:16-23.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 22]  [Cited by in F6Publishing: 23]  [Article Influence: 1.6]  [Reference Citation Analysis (0)]
28.  Wong A, Macleod D, Robinson J, Koutsogiannis Z, Graudins A, Greene SL. Oxycodone/naloxone preparation can cause acute withdrawal symptoms when misused parenterally or taken orally. Clin Toxicol (Phila). 2015;53:815-818.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 9]  [Cited by in F6Publishing: 10]  [Article Influence: 1.1]  [Reference Citation Analysis (0)]
29.  Casado-Espada NM, Martín C, De La Iglesia-Larrad JI, De Alarcón R, Fombellida CI, Fernández-Martín LC, Roncero C. Psychotic symptoms following oxycodone withdrawal, case report and update. Eur Rev Med Pharmacol Sci. 2019;23:6315-6320.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in F6Publishing: 1]  [Reference Citation Analysis (0)]
30.  Lalovic B, Kharasch E, Hoffer C, Risler L, Liu-Chen LY, Shen DD. Pharmacokinetics and pharmacodynamics of oral oxycodone in healthy human subjects: role of circulating active metabolites. Clin Pharmacol Ther. 2006;79:461-479.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 315]  [Cited by in F6Publishing: 323]  [Article Influence: 17.9]  [Reference Citation Analysis (0)]
31.  Olesen AE, Staahl C, Arendt-Nielsen L, Drewes AM. Different effects of morphine and oxycodone in experimentally evoked hyperalgesia: a human translational study. Br J Clin Pharmacol. 2010;70:189-200.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 54]  [Cited by in F6Publishing: 57]  [Article Influence: 4.4]  [Reference Citation Analysis (0)]
32.  Lenz H, Sandvik L, Qvigstad E, Bjerkelund CE, Raeder J. A comparison of intravenous oxycodone and intravenous morphine in patient-controlled postoperative analgesia after laparoscopic hysterectomy. Anesth Analg. 2009;109:1279-1283.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 80]  [Cited by in F6Publishing: 89]  [Article Influence: 5.9]  [Reference Citation Analysis (0)]
33.  Caraceni A, Pigni A, Brunelli C. Is oral morphine still the first choice opioid for moderate to severe cancer pain? Palliat Med. 2011;25:402-409.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 66]  [Cited by in F6Publishing: 67]  [Article Influence: 5.2]  [Reference Citation Analysis (0)]
34.  Holzer P, Ahmedzai SH, Niederle N, Leyendecker P, Hopp M, Bosse B, Spohr I, Reimer K. Opioid-induced bowel dysfunction in cancer-related pain: causes, consequences, and a novel approach for its management. J Opioid Manag. 2009;5:145-151.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 64]  [Cited by in F6Publishing: 72]  [Article Influence: 4.8]  [Reference Citation Analysis (0)]
35.  Raffaeli W, Pari C, Corvetta A, Sarti D, Di Sabatino V, Biasi G, Galeazzi M. Oxycodone/acetaminophen at low dosage: an alternative pain treatment for patients with rheumatoid arthritis. J Opioid Manag. 2010;6:40-46.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 8]  [Cited by in F6Publishing: 11]  [Article Influence: 0.8]  [Reference Citation Analysis (0)]
36.  Gatti A, Mammucari M, Sabato E, Masucci L, Sabato AF. Adherence and long-term effect of oxycodone/paracetamol in chronic noncancer pain: a retrospective study. Adv Ther. 2011;28:418-426.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 7]  [Cited by in F6Publishing: 7]  [Article Influence: 0.5]  [Reference Citation Analysis (0)]
37.  De Giorgio R, Zucco FM, Chiarioni G, Mercadante S, Corazziari ES, Caraceni A, Odetti P, Giusti R, Marinangeli F, Pinto C. Management of Opioid-Induced Constipation and Bowel Dysfunction: Expert Opinion of an Italian Multidisciplinary Panel. Adv Ther. 2021;38:3589-3621.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 2]  [Cited by in F6Publishing: 21]  [Article Influence: 7.0]  [Reference Citation Analysis (0)]
38.  Mehta N, Slatkin NE, Israel RJ, Stambler N. Attrition of methylnaltrexone treatment-emergent adverse events in patients with chronic noncancer pain and opioid-induced constipation: a post hoc pooled analysis of two clinical trials. F1000Res. 2021;10:891.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 1]  [Cited by in F6Publishing: 1]  [Article Influence: 0.3]  [Reference Citation Analysis (0)]
39.  Largent-Milnes TM, Guo W, Wang HY, Burns LH, Vanderah TW. Oxycodone plus ultra-low-dose naltrexone attenuates neuropathic pain and associated mu-opioid receptor-Gs coupling. J Pain. 2008;9:700-713.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 53]  [Cited by in F6Publishing: 51]  [Article Influence: 3.2]  [Reference Citation Analysis (0)]
40.  Smith K, Hopp M, Mundin G, Bond S, Bailey P, Woodward J, Palaniappan K, Church A, Limb M, Connor A. Naloxone as part of a prolonged release oxycodone/naloxone combination reduces oxycodone-induced slowing of gastrointestinal transit in healthy volunteers. Expert Opin Investig Drugs. 2011;20:427-439.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 33]  [Cited by in F6Publishing: 40]  [Article Influence: 3.1]  [Reference Citation Analysis (0)]
41.  Sandner-Kiesling A, Leyendecker P, Hopp M, Tarau L, Lejcko J, Meissner W, Sevcik P, Hakl M, Hrib R, Uhl R, Dürr H, Reimer K. Long-term efficacy and safety of combined prolonged-release oxycodone and naloxone in the management of non-cancer chronic pain. Int J Clin Pract. 2010;64:763-774.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 71]  [Cited by in F6Publishing: 80]  [Article Influence: 5.7]  [Reference Citation Analysis (0)]
42.  Hermanns K, Junker U, Nolte T. Prolonged-release oxycodone/naloxone in the treatment of neuropathic pain - results from a large observational study. Expert Opin Pharmacother. 2012;13:299-311.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 21]  [Cited by in F6Publishing: 28]  [Article Influence: 2.3]  [Reference Citation Analysis (0)]
43.  Webster L, Richards P, Stern W, Kelen R; MoxDuo Study Group. A double-blind, placebo-controlled study of dual-opioid treatment with the combination of morphine plus oxycodone in patients with acute postoperative pain. J Opioid Manag. 2010;6:329-340.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 17]  [Cited by in F6Publishing: 17]  [Article Influence: 1.2]  [Reference Citation Analysis (0)]
44.  Kinnunen M, Piirainen P, Kokki H, Lammi P, Kokki M. Updated Clinical Pharmacokinetics and Pharmacodynamics of Oxycodone. Clin Pharmacokinet. 2019;58:705-725.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 47]  [Cited by in F6Publishing: 33]  [Article Influence: 6.6]  [Reference Citation Analysis (0)]
45.  Richards P, Riff D, Kelen R, Stern W; MoxDuo Study Team. Analgesic and adverse effects of a fixed-ratio morphine-oxycodone combination (MoxDuo) in the treatment of postoperative pain. J Opioid Manag. 2011;7:217-228.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 30]  [Cited by in F6Publishing: 31]  [Article Influence: 2.4]  [Reference Citation Analysis (0)]
46.  Liu YL, Yan LD, Zhou PL, Wu CF, Gong ZH. Levo-tetrahydropalmatine attenuates oxycodone-induced conditioned place preference in rats. Eur J Pharmacol. 2009;602:321-327.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 39]  [Cited by in F6Publishing: 36]  [Article Influence: 2.4]  [Reference Citation Analysis (0)]
47.  Liu YL, Liang JH, Yan LD, Su RB, Wu CF, Gong ZH. Effects of l-tetrahydropalmatine on locomotor sensitization to oxycodone in mice. Acta Pharmacol Sin. 2005;26:533-538.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 37]  [Cited by in F6Publishing: 40]  [Article Influence: 2.1]  [Reference Citation Analysis (0)]
48.  Hanna M, O'Brien C, Wilson MC. Prolonged-release oxycodone enhances the effects of existing gabapentin therapy in painful diabetic neuropathy patients. Eur J Pain. 2008;12:804-813.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 171]  [Cited by in F6Publishing: 154]  [Article Influence: 9.6]  [Reference Citation Analysis (0)]
49.  Zacny JP, Paice JA, Coalson DW. Subjective, psychomotor, and physiological effects of pregabalin alone and in combination with oxycodone in healthy volunteers. Pharmacol Biochem Behav. 2012;100:560-565.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 29]  [Cited by in F6Publishing: 30]  [Article Influence: 2.3]  [Reference Citation Analysis (0)]
50.  Adachi YU, Satomoto M, Higuchi H, Watanabe K. Fentanyl attenuates the hemodynamic response to endotracheal intubation more than the response to laryngoscopy. Anesth Analg. 2002;95:233-237, table of contents.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 51]  [Cited by in F6Publishing: 61]  [Article Influence: 2.8]  [Reference Citation Analysis (0)]
51.  Coe MA, Lofwall MR, Vessels V, Nuzzo PA, Walsh SL. Evaluation of tradipitant, a selective NK1 antagonist, on response to oxycodone in humans. Psychopharmacology (Berl). 2021;238:1857-1866.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 2]  [Cited by in F6Publishing: 2]  [Article Influence: 0.7]  [Reference Citation Analysis (1)]
52.  Dai B, Cao X. Comparing the different oxycodone doses of prevent oxycodone for prevention of preventing fentanyl-induced cough during induction of general anaesthesia. Int J Clin Pract. 2020;74:e13642.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 3]  [Cited by in F6Publishing: 3]  [Article Influence: 0.8]  [Reference Citation Analysis (0)]
53.  Wadbrook PS. Advances in airway pharmacology. Emerging trends and evolving controversy. Emerg Med Clin North Am. 2000;18:767-788.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 20]  [Cited by in F6Publishing: 22]  [Article Influence: 0.9]  [Reference Citation Analysis (0)]
54.  Jiang M, Ji J, Li X, Liu Z. Effect of intravenous oxycodone on the physiologic responses to extubation following general anesthesia. BMC Anesthesiol. 2021;21:146.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 1]  [Cited by in F6Publishing: 5]  [Article Influence: 1.7]  [Reference Citation Analysis (0)]
55.  Bao F, Xie Q, Zhang H, Zhu S, Kang X. Feasibility of using oxycodone as the sole opioid for induction and maintenance of general anaesthesia in minor/moderate surgery: a prospective, observational, descriptive study. J Int Med Res. 2020;48:300060520957500.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 3]  [Cited by in F6Publishing: 3]  [Article Influence: 1.0]  [Reference Citation Analysis (0)]
56.  Wirz S, Ellerkmann RK, Soehle M, Wirtz CD. Oxycodone is safe and effective for general anesthesia. J Opioid Manag. 2018;14:125-130.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 4]  [Cited by in F6Publishing: 3]  [Article Influence: 0.5]  [Reference Citation Analysis (0)]
57.  Kwak HJ, Kim JY, Kim YB, Min SK, Moon BK. Pharmacological prevention of rocuronium-induced injection pain or withdrawal movements: a meta-analysis. J Anesth. 2013;27:742-749.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 14]  [Cited by in F6Publishing: 13]  [Article Influence: 1.2]  [Reference Citation Analysis (0)]
58.  An X, Li C, Sahebally Z, Wen X, Zhao B, Fang X. Pretreatment with Oxycodone Simultaneously Reduces Etomidate-Induced Myoclonus and Rocuronium-Induced Withdrawal Movements During Rapid-Sequence Induction. Med Sci Monit. 2017;23:4989-4994.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 2]  [Cited by in F6Publishing: 2]  [Article Influence: 0.3]  [Reference Citation Analysis (0)]
59.  Wang W, Lv J, Wang Q, Yang L, Yu W. Oxycodone for prevention of etomidate-induced myoclonus: a randomized double-blind controlled trial. J Int Med Res. 2018;46:1839-1845.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 2]  [Cited by in F6Publishing: 2]  [Article Influence: 0.3]  [Reference Citation Analysis (0)]