Objective To observe the efficacy of oxycodone under no background dose in patient-controlled intravenous analgesia (PCIA)after caesarean surgery. Methods Sixty patients undergoing selective cesarean section were randomly categorized into two groups using random schedule table(n=30): group morphine(group M) and group oxycodone(group O), all patients were aged between 20 to 35 years and of ASA classⅠ, Ⅱ.Fifty milligrams of morphine was delivered in group M, while 50 mg oxycodone was delivered in group O.Ondansetron 8 mg was added to each group.PCIA was set on demand mode without loading dose or background infusion.In both groups,drugs were diluted to 100 ml with normal saline,and 4 ml bolus dose with 5 min lockout interval was set.At 4, 8, 12 h and 48 h after surgery, VAS was assessed, including VAS at rest, VAS at motion and VAS at uterine contraction. Total doses of the drug delivery within postoperative 48 h and the number of patient controlled analgesia(PCA)were recorded,postoperative nausea and vomiting and patient satisfaction were also evaluated. Results At 4, 8, 12 h and 24 h after surgery, VAS at uterine contraction in group O was significantly lower than VAS of group M(P<0.05).No significant differences were detected between the two groups in VAS at rest and motion at all time points(P>0.05).At 48 h after surgery,total doses of PCIA drugs,the number of PCA and the incidences of side effects were significantly lower in group O than these parameters in group M (P<0.05). The overall patient satisfaction degree in group O was significantly higher than patient satisfaction degree in group O (P<0.05). Conclusions Both oxycodone and morphine are effective for pain relief after cesarean section when PCIA is set on bolus mode.However,compared with morphine,oxycodone exhibited significantly better effects on uterine contraction,pain relief and patient satisfaction.

Background: Although nonoperative management for perforated peptic ulcer (PPU) has been used for several decades, the indication is still unclear. A clinicoradiological score was sought to predict who can benefit from it.Methods: A clinicoradiological protocol for the assessment of patients presenting with PPU was used. A logistic regression model was applied to identify determinant variables and construct a clinical score that would identify patients who can be successfully treated with nonoperative management.Results: Of 241 consecutive patients with PPU, 107 successfully received nonoperative management, and 134 required surgery. In multivariable analysis, the following four variables correlated with surgery and were given one point each toward the clinical score: age >= 70 years, fluid collection detection by ultrasound, contrast extravasation detection by watersoluble contrast examination, and Acute Physiology and Chronic Health Evaluation II (APACHE II) score >= 8. Eighty-five percent of patients with a score of 1 or less were successfully treated with nonoperative management, whereas 23 of 29 patients with a score of 3 or more required surgery. The area under the receiver operating characteristic curve was 0.804 (95% confidence interval = 0.717-0.891).Conclusion: By combining clinical, radiological parameters, and APACHE II score, the clinical score allowed early identification of PPU patients who can benefit from nonoperative management. Copyright (C) 2013, Asian Surgical Association. Published by Elsevier Taiwan LLC. All rights reserved.