Prolonged Release Oxycodone/Naloxone vs Other Opioids for Post-TKR Pain

Use of prolonged release oxycodone/naloxone was associated with increased participation in physical therapy and improved functional results post-total knee replacement, as compared with other opioids.

Prolonged-release oxycodone/naloxone (OXN) may improve overall functional outcomes and increase participation in physical therapy in patients who have had total knee replacement (TKR) when compared to other opioids, according to a study published in the Journal of Clinical Anesthesia.

Johannes Oppermann, MD, from the Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne in Germany, and colleagues compared the effect of postoperative prolonged-release OXN with other opioids regarding patients’ early rehabilitation outcome after TKR. A total of 80 patients were assigned to the OXN group or to a control group in the prospective, nonrandomized clinical trial.

The investigators evaluated postoperative outcome and pain level at 3, 6, 21, and 35 days and at 6 months with use of the Bowel Function Index, Brief Pain Inventory Short Form questionnaire, the Hospital for Special Surgery score, modified Larson score, and the ability to attend physiotherapy. All medications were recorded, and a safety analysis was conducted.

High Yield Data Summary

  • Use of prolonged release oxycodone/naloxone was associated with increased participation in physical therapy with no restrictions and improved Larson Function Scores post-TKR, as compared with other opioids

The researchers found no significant differences between the 2 groups regarding pain levels. Patients in the OXN group reported better bowel function (median value, 0.0 for the OXN group; median value, 20.0 for the control group). 

No effect of treatment group and no treatment-by-visit interaction on Hospital for Special Surgery final score were found. However, the Larson function score in the early postoperative phase was “significantly better in the OXN group,” noted Dr Oppermann’s group.

In addition, the proportion of patients in the OXN group who were able to attend physiotherapy without any restriction was 58.1%. The proportion of patients in the OXN group who experienced mild or moderate adverse drug reactions was 23.3%, compared with a rate of 37.8% in the control group. 

No serious adverse drug reactions were observed.

OXN provides an effective analgesia and offers several benefits such as higher ability to participate in physiotherapy and better functional results,” stated the researchers. “Incidence and severity of constipation can be reduced by using prolonged-released OXN as compared with other opioids.”


  1. Oppermann J, Bredow J, Spies CK,  et al. Effect of prolonged-released oxycodone/naloxone in postoperative pain management after total knee replacement: a nonrandomized prospective trial. J Clin Anesth. 2016;33:491-497. doi: 10.1016/j.jclinane.2016.04.002.

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This article originally appeared on Clinical Advisor