Abstract: Objective To evaluate the safety and effectiveness of different doses of epidural oxycodone injection for traction reaction during cesarean sections to determine the optimal dose. Methods Totally 119 cases of parturients who underwent cesarean sections from October 2023 to May 2024 were selected and randomly divided into groups A, B, C and D. All four groups of lying-in women received epidural injection after the umbilical cord was cut. Groups A,B and C were given oxycodone 3 mg, 5 mg and 7 mg respectively, and group D was given an equal amount of normal saline.The primary outcomes were documentation of maternal vital signs and traction reaction during the surgery.Secondary outcomes included patient-controlled intravenous analgesia(PCIA) times within 48 hours and documentation of any postoperative adverse events within 24 hours. Results The comparison of intra-operative vital signs among the four groups of patients revealed no statistically significant differences. In groups A, B and C the incidence of traction reactions was significantly lower at 20%, 17.2% and 3.3%, respectively, compared to group D at 53.3%, showing statistically significant differences(P＜0.05). Additionally, the incidence of traction reaction in group C was significantly lower than in group A(P＜0.05).Groups A, B and C produced significantly better results than group D in terms of the duration of anesthesia. PCIA presses were substantially less in groups A and C than in group D(P＜0.05), and group C had a significantly higher total incidence of adverse events than group A and group D(P＜0.05). Conclusions Epidural injection of 3 mg, 5 mg and 7 mg oxycodone has been proved to significantly reduce traction reaction during cesarean sections while minimally impacting intraoperative vital signs. This intervention has the potential to extend the duration of anesthesia, decrease the frequency of PCIA presses. Among these, 7 mg is the most effective but has the highest incidence of adverse effects, requiring carefully post-operative monitoring.

Key words: oxycodone, cesarean section, traction reaction, visceral pain, neuraxial anesthesia