Discussion
PONV, postoperative pain, nausea and vomiting, pain
ADVERSE EFFECTS, ADVERSE EFFECT
There are several reasons for the cautious use of opioids in pediatric postoperative pain management, one of which is the fear of potential severe adverse effects due to children’s young age and small size. Although oral oxycodone has been widely used for pain relief in children, there is no literature on the use of intravenous oxycodone for postoperative pain relief in pediatric. In this study, we investigated whether intravenous oxycodone can provide adequate and safe postoperative pain relief, in comparison to intravenous tramadol which has a well-established use in children [Oxycodone elimination is slower and its pharmacokinetics are more variable in neonates, particularly preterm newborns, and thus a lower dose with a longer dosing interval is recommended in these patients [Our study showed that children patients administrated with an equal dose of oxycodone or tramadol did not show any difference in the FLACC scores after extubation, the requirement for rescues analgesia in PACU. These results suggest that oxycodone could provide adequate transition analgesia compared with the equal dose of tramadol immediately after surgery, in line with previous studies conducted in adults [After returning to the wards, we did not record any requirements for the alternative rescue analgesia in either oxycodone or tramadol groups, suggesting that both oxycodone and tramadol-PCIA provide adequate postoperative pain control in children patients. Additionally, there was no significant difference in the bolus dose administration, including bolus dose times, the anesthetics consumption equivalent with morphine, the length between the first bolus dose and the discharge from PACU, and FAS scores between the two groups, demonstrating that oxycodone and tramadol have similar efficacy in providing postoperative analgesia in pediatric patients. Differently with the period of staying in PACU, we did not observe any cases of oversedation or significant differences in Ramsay scores between the oxycodone and tramadol groups in the ward. Considering the much lower dose administrated during PCIA infusion in the wards compared with the loading dose at the end of surgery, this result further illustrated that the higher sedation effect of tramadol relative to oxycodone observed in PCAU was dose-associated.Our results align with previous studies that show that nausea and vomiting (PONV) is the most frequently reported adverse effect in both the oxycodone and tramadol groups [This study has several limitations that need to be considered: firstly, we administered only a single dose of either oxycodone or tramadol. In another preliminary study we performed, 0.05, 0.1, and 0.15 mg.kg