Oxycodone vs. fentanyl for post-ERCP pain and inflammation control in children

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Created On: 22/04/2025

Postoperative visceral pain is often a challenging complication following endoscopic retrograde cholangiopancreatography (ERCP).

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Key take away

Compared to fentanyl, oxycodone provides superior pain relief, lower inflammatory cytokines, and fewer instances of postoperative vomiting in children undergoing ERCP.

Background

Postoperative visceral pain is often a challenging complication following endoscopic retrograde cholangiopancreatography (ERCP). This randomized, double-blind study explored the effectiveness of oxycodone versus fentanyl in tackling pain and inflammation in pediatric patients undergoing ERCP.

Method

Overall, 82 children (aged 2–18 years) scheduled for elective ERCP were assigned to get either oxycodone (0.2 mg/kg) or fentanyl (2 μg/kg). Pain was assessed at 10, 20, and 30 minutes in the post-anesthesia care unit, and at 6 and 24 hours post-procedure on the ward. Inflammatory cytokines, including interleukin (IL)-6, IL-10, and tumor necrosis factor-alpha (TNF-α) were estimated at baseline, 6 hours, and 24 hours after ERCP.

Result

Participants receiving oxycodone experienced lower pain scores at 30 minutes, 6 hours, and 24 hours after ERCP compared to those receiving fentanyl. At 10 and 20 minutes, pain scores were comparable between the groups. Additionally, fewer children in the oxycodone group exhibited pain scores of 3 or higher at 6 and 24 hours after the procedure. The occurrence of postoperative vomiting was lower among those treated with oxycodone. On the other hand, the incidence of post-ERCP pancreatitis was similar across the groups, as shown in Table 1:

Additionally, the oxycodone group exhibited lower levels of inflammatory markers (IL-6 at 6 hours and TNF-α at 24 hours).

Conclusion

Oxycodone (0.2 mg/kg) provides reliable pain control and stable hemodynamics in pediatric patients undergoing ERCP, which may be attributed to its ability to reduce inflammation following the procedure.