Cardiovascular safety and analgesic efficacy of oxycodone for postoperative intravenous patient-controlled analgesia

LIU Wen-guang; SHAN Wen-ting; LIU Hua-dong; LI Jun-feng

doi:10.3969/j.issn.1009-8933.2025.03.002

Abstract：Background: Postoperative pain, if not effectively controlled, can trigger sympathetic activation and stress responses that increase the risk of cardiovascular complications. Oxycodone, a semisynthetic opioid acting on both μ- and κ-receptors, may provide stable analgesia with less hemodynamic fluctuation compared with the pure μ-agonist sufentanil. This study aimed to compare the efficacy and cardiovascular safety of oxycodone-based versus sufentanil-based intravenous patient-controlled analgesia (IV-PCA) after laparoscopic abdominal surgery. Methods: This single-center retrospective comparative study included patients who underwent laparoscopic abdominal surgery between March 2024 and March 2025. According to their postoperative PCA regimen, patients were divided into an oxycodone group and a sufentanil group. The primary endpoint was the incidence of cardiovascular adverse events (CVAE) within 48 h after surgery, including hypotension, bradycardia, and arrhythmia. Logistic regression was used to identify independent predictors of CVAE, and receiver operating characteristic (ROC) analysis assessed discriminative performance. Results: A total of 356 patients were analyzed (oxycodone n=197; sufentanil n=159). The incidence of CVAE was significantly lower in the oxycodone group than in the sufentanil group (5.2% vs. 12.1%, P=0.021). Oxycodone provided comparable analgesic intensity with fewer PCA bolus attempts (36±15 vs. 52±17, P<0.001) and higher patient satisfaction scores (4.3±0.5 vs. 4.1±0.5, P=0.002). Multivariate logistic regression identified sufentanil use (OR: 2.53, 95% CI: 1.16–5.84, P=0.018) as independent predictors of CVAE. Conclusions: Oxycodone-based IV-PCA provided effective postoperative analgesia with a lower incidence of cardiovascular adverse events compared with sufentanil-based PCA. The results suggested that oxycodone offered a favorable balance between analgesic efficacy and hemodynamic stability, making it a safer alternative for postoperative pain management in patients at cardiovascular risk. [S Chin J Cardiol 2025;26(3):145–154]