Effects of Oxycodone versus Sufentanil-Based Intravenous Patient-Controlled Multimodal Analgesia on Early Gastrointestinal Recovery and Pain After Laparoscopic Colorectal Cancer Surgery: A Randomized Double-Blind Trial

Purpose: Oxycodone is a dual μ/κ-opioid receptor agonist effective in managing both somatic and visceral pain. We compared the effect of oxycodone-based versus sufentanil-based multimodal regimens on early gastrointestinal recovery and pain control following laparoscopic colorectal cancer surgery. Methods: In this single-center, prospective, randomized, double-blind trial, 76 patients undergoing elective laparoscopic colorectal cancer surgery were allocated to the oxycodone group (Group O) or the sufentanil group (Group S). Both groups received standardized multimodal analgesia with preoperative TAP block, postoperative PCIA, and flurbiprofen axetil for rescue. The primary endpoint was time to first flatus; secondary outcomes included other recovery indicators, pain and sedation scores, opioid and PCIA use, adverse effects, PACU stay, and hospital length of stay. Results: Group O shortened time to first flatus (43.7± 7.9 h vs 48.4± 8.7 h, mean difference − 4.8 h; 95% CI − 8.6 to − 1.0; P = 0.015) and time to ambulation (47.3± 5.1 h vs 50.0± 3.8 h, mean difference − 2.7 h; 95% CI − 4.8 to − 0.7; P = 0.010). Group O reduced PCIA demands (median 0 vs 2), rescue analgesia (7.9% vs 26.3%), PONV (7.9% vs 31.6%), PACU stay (median 55 vs 60 min), and remifentanil use (2.8± 0.4 vs 3.1± 0.5 mg) (all P < 0.05). Postoperative sedation at 4 h was better in group O. Visceral pain scores at 12 h and 48 h were lower with oxycodone, whereas incisional pain and solid-food tolerance did not differ; length of stay was similar. Conclusion: Oxycodone-based multimodal analgesia was associated with improved early gastrointestinal recovery indicators, better visceral pain control, and fewer opioid-related adverse effects than the sufentanil-based regimen, but did not reduce hospital length of stay. Trial Registration: Chinese Clinical Trial Registry (ChiCTR2500100676). Keywords: oxycodone, laparoscopic colorectal surgery, gastrointestinal recovery, multimodal analgesia, enhanced recovery after surgery, ERAS