"Opioid creep" is real and may be the cause of "fluid creep".
Recent studies have shown that burn patients receive larger volumes of fluids than predicted by the Baxter formula and the reason for this is unclear. One potential reason is that increased analgesics are used which could blunt the response to fluid resuscitation. The purpose of this study was to compare the administration of opioid agonists in patients treated at a single burn center in the 1970s and in the year 2000. We performed a retrospective chart review comparing two matched cohorts. Group I consisted of 11 patients admitted between 1975 and 1978. Group II consisted of 11 patients admitted in 2000 matched for age, sex and %TBSA. Patients in Group II received a significantly higher mean opioid equivalent than those in Group I (26.5 +/- 12.3 versus 3.9 +/- 2.2 in the first 24h, P < 0.001). In addition, in Group II, a larger variety and combination of opioid agonists were used. This review demonstrates a significant increase from the 1970s to 2000 in the type, dose prescribed and dose delivered of opioid agonists. Along with "fluid creep", we have also increased our use of opioid agonists or "opioid creep". Higher doses of opioid agonists may have hemodynamic consequences, which may contribute to the increased fluid volumes.
Harborview Medical Center, Division of Plastic Surgery, University of Washington, Harborview Medical Center, Box 359796, 325 Ninth Avenue, Seattle, WA, USA.
Stephen R
SR
Sullivan
Jeffrey B
JB
Friedrich
Loren H
LH
Engrav
Kurt A
KA
Round
David M
DM
Heimbach
Susan R
SR
Heckbert
Gretchen J
GJ
Carrougher
Dennis C
DC
Lezotte
Shelley A
SA
Wiechman
Shari
S
Honari
Matthew B
MB
Klein
Nicole S
NS
Gibran
D000293:Adolescent; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D001830:Body Surface Area; D002056:Burns / Q000188:drug therapy*; D005260:Female; D005283:Fentanyl / Q000009:adverse effects; D005440:Fluid Therapy / Q000009:adverse effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008297:Male; D008614:Meperidine / Q000008:administration & dosage / Q000009:adverse effects; D008691:Methadone / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D009020:Morphine / Q000009:adverse effects; D009294:Narcotics / Q000008:administration & dosage / Q000009:adverse effects*; D012189:Retrospective Studies
D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D009294:Narcotics; D009020:Morphine; D008614:Meperidine; D008691:Methadone; D005283:Fentanyl