• Anesthesia and analgesia · Dec 2016

    Comparative Study Observational Study

    Long-Acting Patient-Controlled Opioids Are Not Associated With More Postoperative Hypoxemia Than Short-Acting Patient-Controlled Opioids After Noncardiac Surgery: A Cohort Analysis.

    • Allan W Belcher, Ashish K Khanna, Steve Leung, Amanda J Naylor, Matthew T Hutcherson, Bianka M Nguyen, Natalya Makarova, Daniel I Sessler, P J Devereaux, and Leif Saager.
    • From the *Departments of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio; †Center for Critical Care, Cleveland Clinic, Cleveland, Ohio; ‡Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio; §Hamilton Health Sciences, Cardiac Care Unit, McMaster University, Hamilton, Ontario, Canada; ‖Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; and Departments of ¶Outcomes Research, #General Anesthesiology, Cleveland, Ohio.
    • Anesth. Analg. 2016 Dec 1; 123 (6): 1471-1479.

    BackgroundOpioids can contribute to postoperative desaturation. Short-acting opioids, titrated to need, may cause less desaturation than longer-acting opioids. We thus tested the primary hypothesis that long-acting patient-controlled intravenous opioids are associated with more hypoxemia (defined as an integrated area under a postoperative oxyhemoglobin saturation of 95%) than short-acting opioids.MethodsThis analysis was a substudy of VISION, a prospective cohort study focused on perioperative cardiovascular events (NCT00512109). After excluding for predefined criteria, 191 patients were included in our final analysis, with 75 (39%) patients being given fentanyl (short-acting opioid group) and 116 (61%) patients being given morphine and/or hydromorphone (long-acting opioid group). The difference in the median areas under a postoperative oxyhemoglobin saturation of 95% between short-acting and long-acting opioids was compared using multivariable median quantile regression.ResultsThe short-acting opioid median area under a postoperative oxyhemoglobin saturation of 95% per hour was 1.08 (q1, q3: 0.62, 2.26) %-h, whereas the long-acting opioid median was 1.28 (0.50, 2.23) %-h. No significant association was detected between long-acting and short-acting opioids and median area under a postoperative oxyhemoglobin saturation of 95% per hour (P = .66) with estimated change in the medians of -0.14 (95% CI, -0.75, 0.47) %-h for the patients given long-acting versus short-acting IV patient-controlled analgesia opioids.ConclusionsLong-acting patient-controlled opioids were not associated with the increased hypoxemia during the first 2 postoperative days.

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