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Randomized Controlled Trial
. 2025 Jun 9:19:4979-4990.
doi: 10.2147/DDDT.S524102. eCollection 2025.

Oxycodone vs the Combination of Fentanyl and Remifentanil for General Anesthesia in Laparoscopic Uterine Myomas Surgery: A Prospective, Randomized, Controlled Study

Xiaowei Xu #  1 , Honggang Zhang #  1 , Jun Li #  2 , Li Zhou  1   3 , Shengmei Zhu  1 , Fangping Bao  1
Affiliations
Randomized Controlled Trial

Oxycodone vs the Combination of Fentanyl and Remifentanil for General Anesthesia in Laparoscopic Uterine Myomas Surgery: A Prospective, Randomized, Controlled Study

Xiaowei Xu et al. Drug Des Devel Ther. .

Abstract

Purpose: This study evaluated whether oxycodone alone could substitute for fentanyl combined with remifentanil for general anesthesia in laparoscopic uterine myoma surgery.

Patients and methods: 90 adult female patients were randomized into three groups: oxycodone 0.35 mg/kg (Group A), oxycodone 0.30 mg/kg (Group B), or fentanyl 5 μg/kg (Group C) for induction. Anesthesia was maintained with propofol plus saline (Groups A/B) or remifentanil (Group C). Primary outcomes included Numerical Rating Scale (NRS) pain scores in the Post-Anesthesia Care Unit (PACU). Secondary outcomes were intubation reaction, vital signs, extubation/PACU times, Ramsey Sedation Scores (RSS) in PACU, NRS pain scores and adverse events within 48 hours postoperatively.

Results: Intubation reactions were rare (one case each in Groups B/C, none in Group A). Group B had significantly lower PACU NRS scores than Group C (0.6 ± 0.7 vs 1.3 ± 1.4, P = 0.011), while Group A showed a nonsignificant trend (0.8 ± 0.9 vs 1.3 ± 1.4, P = 0.051). RSS scores, extubation/PACU times, and 48-hour NRS scores were comparable. However, oxycodone groups had longer postoperative evacuation times than fentanyl group (Group A vs Group C: 20.0 ± 7.3 hours vs 16.5 ± 5.1 hours, P=0.038; Group B vs Group C: 20.3 ± 8.2 hours vs 16.5 ± 5.1 hours, P=0.034).

Conclusion: Oxycodone alone provides superior early postoperative analgesia compared to fentanyl-remifentanil in laparoscopic myoma surgery but may delay bowel recovery.

Keywords: fentanyl; laparoscopic surgery; myomas; oxycodone; postoperative pain.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Consolidated Standards of Reporting Trials (CONSORT) flow diagram.
Figure 2
Figure 2
Blood pressure (BP) and heart rate (HR) at perioperative period. (a) Systolic blood pressure (SBP) and diastolic blood pressure (DBP), (b) heart rate (HR). Anesthesia induction: oxycodone 0.35 mg/kg (group A), oxycodone 0.30 mg/kg (group B), or fentanyl 5 μg/kg (group C) T0 = arrival in the operating room; T1 = before intubation; T2 = 1 minute after intubation; T3 = skin incision; T4 = artificial pneumoperitoneum; T5 = head-down position; T6 = 30 minutes after the start of surgery; T7 = 60 minutes after the start of surgery; T8 = end of the operation; T9 = extubation time.
Figure 3
Figure 3
The total dose of propofol. Anesthesia induction: oxycodone 0.35 mg/kg (group A), oxycodone 0.30 mg/kg (group B), or fentanyl 5 μg/kg (group C), ** presents P <0.01, *** presents P<0.001. The total dose of propofol includes induction and maintenance doses.
Figure 4
Figure 4
NRS and RSS in different states at different times. Three groups of patients’ NRS (a) and RSS (b) scores in PACU. NRS scores of three groups of patients at rest (c) and during movement (d) within 48 hours after surgery. Anesthesia induction: oxycodone 0.35 mg/kg (group A), oxycodone 0.30 mg/kg (group B), or fentanyl 5 μg/kg (group C), * presents P <0.05.
Figure 5
Figure 5
Evacuation time in each group. Anesthesia induction: oxycodone 0.35 mg/kg (group A), oxycodone 0.30 mg/kg (group B), or fentanyl 5 μg/kg (group C), * presents P <0.05.
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