Pre-emptive Oxycodone versus Sufentanil for Acute and Delayed Pain after Transcatheter Arterial Chemoembolization: A Randomized Controlled Trial with Inflammatory Biomarker Analysis

PURPOSE To compare the efficacy of preemptive oxycodone versus sufentanil for acute and delayed pain control after transcatheter arterial chemoembolization (TACE). MATERIALS AND METHODS In this prospective, double-blind trial, 40 patients scheduled for TACE were randomized to receive intravenous oxycodone (0.1 mg/kg) or sufentanil (0.1 μg/kg) 15 minutes pre-TACE. Pain intensity was assessed using a visual analogue scale (VAS) during acute (0-24h) and delayed (days 2-7) phases. Inflammatory biomarkers (white blood cell count, neutrophil percentage, C-reactive protein, interleukin-6 IL-6) were measured at baseline and 24 hours post-TACE. The primary outcome was the highest acute-phase VAS scores; secondary outcomes included delayed-phase pain, changes in inflammatory biomarkers, and adverse events. RESULTS Oxycodone demonstrated superior analgesia, with lower (median, interquartile rangeIQR) intraprocedural VAS scores (00-1.0 vs 3.51.3-4.8, P<0.001) and reduced incidence of moderate-to-severe pain (5% vs 50%, P=0.003). This benefit persisted at 1-6 hours post-TACE (00-1.0 vs 20-3.0, P=0.042). During the delayed phase, oxycodone maintained lower pain scores (00-0 vs 00-3.8, P=0.042) and fewer episodes of moderate pain (0% vs 25%, P=0.047). IL-6 elevation was greater in patients developing delayed pain (671.16% vs 135.97% increase, P=0.030). Adverse event rates were comparable. CONCLUSION Preemptive oxycodone provided more effective acute and delayed pain control after TACE compared to sufentanil, with comparable safety. The association between IL-6 elevation and delayed pain suggests an inflammatory pain component, supporting further investigation of combined opioid and anti-inflammatory strategies.