Results of forty years Yellow Card reporting for commonly used perioperative analgesic drugs.
BACKGROUND
A variety of analgesics are used perioperatively and associated adverse drug reactions (ADRs) may complicate anaesthesia and recovery.


METHODS
We aimed to measure the demographics of reported suspected ADRs to alfentanil, fentanyl, ketorolac, morphine, nalbuphine, papaveretum, pethidine and remifentanil. We report a retrospective analysis of Yellow Card reports of suspected ADRs from 1965-2004 as classified in the Adverse Drug Reaction On-line Tracking database (ADROIT) of the Medicines and Healthcare products Regulatory Agency (MHRA).


RESULTS
In total, 1312 reactions were retrieved. A single drug was reported in 908, 39 were fatal and 219 categorised as 'allergic'. Allergic phenomenon varied from 2/33 (6%) for remifentanil to 11/53 (21%) for alfentanil. 'Cardiovascular' reactions were reported frequently with remifentanil (18/33, 55%) and alfentanil (19/53, 36%) and these generated a signal for possible hazards from proportional reporting ratios (PRRs). The opioid fentanyl was associated with similar hazard signals for muscular and psychiatric ADRs.


CONCLUSIONS
Perioperative vigilance may reduce morbidity and mortality from preventable ADRs to analgesic drugs. Denominator and diagnostic data are essential for prospective studies.
Richardson
Jennifer
J
Imperial College London, UK.
Holdcroft
Anita
A
D000293:Adolescent; D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000009:adverse effects*; D004342:Drug Hypersensitivity / Q000453:epidemiology; D005260:Female; D005283:Fentanyl / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D012119:Respiration / Q000187:drug effects; D012189:Retrospective Studies; D013997:Time Factors
D000700:Analgesics; D005283:Fentanyl