Abstract:

Objective To compare the effect of oxycodone and sufentanil on postoperative pain, cognitive function and inflammatory response in elderly patients with endoscopic retrograde cholangiopancreatography (ERCP). Methods Elderly patients scheduled for elective ERCP were selected and divided into the oxycodone group and the sufentanil group by random number table method. Both groups received patient-controlled intravenous analgesia (PCIA) postoperatively, with oxycodone in the oxycodone group and sufentanil in the sufentanil group. A total of 162 patients were ultimately included, including 79 in the oxycodone group and 83 in the sufentanil group. The primary outcome was the resting pain visual analogue scale (VAS) score within 72 hours postoperatively. Secondary indicators included the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores 1 day before the operation and 7 days after the operation, and the incidence of postoperative cognitive dysfunction (POCD), and serum C-reactive protein (CRP) and interleukin-6 (IL-6) levels before the operation and at 6, 24 and 72 hours after the operation. The occurrence of adverse reactions in patients was recorded. Results The VAS scores for pain within 72 hours postoperatively in the oxycodone group were significantly lower than that in the sufentanil group (P<0.01). Seven days after the operation, the oxycodone group had significantly higher MMSE and MoCA scores, and the incidence of POCD was significantly lower (11.39% vs. 26.51%, χ²=5.975, P<0.05). Within 72 hours postoperatively, the CRP and IL-6 levels in the oxycodone group were lower than those in the sufentanil group (P<0.01). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). The VAS score for pain within 72 hours after surgery in the oxycodone group was significantly lower than that in the sufentanil group, and the MMSE score and MoCA score were both higher in the oxycodone group than those in the sufentanil group, and the incidence of POCD (11.39%) was lower than that in the sufentanil group (26.51%). Within 72 hours after the operation, the levels of CRP and IL-6 were lower in the oxycodone group than those in the sufentanil group (P<0.01). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion In elderly ERCP patients, oxycodone provides better postoperative pain relief, has a lesser impact on cognitive function and more effectively suppresses the inflammatory response compared to sufentanil.

Key words: cholangiopancreatography, endoscopic retrograde, pain, postoperatively, sufentanil, oxycodone, postoperative cognitive complications