title: Postoperative continuous intravenous infusion of fentanyl is associated with the development of orthostatic intolerance and delayed ambulation in patients after gynecologic laparoscopic surgery.
abstract: OBJECTIVE
  Early ambulation is essential for rapid functional recovery after surgery; however, orthostatic intolerance may delay recovery and cause syncope, leading to potential serious complications such as falls. Opioids may contribute to orthostatic intolerance because of reduced arterial pressure and associated reduction in cerebral blood flow and oxygenation. This study aimed to examine the effect of postoperative continuous infusion of fentanyl on orthostatic intolerance and delayed ambulation in patients after gynecologic laparoscopic surgery.
  
  
  METHODS
  In this retrospective cohort study, data from 195 consecutive patients who underwent gynecologic laparoscopic surgery were analyzed to evaluate the association between postoperative continuous infusion of fentanyl and the incidence of orthostatic intolerance or delayed ambulation. The primary outcome was defined as delayed ambulation, an inability to ambulate on postoperative day 1. The secondary outcome was defined as orthostatic intolerance and symptoms associated with ambulatory challenge, including dizziness, nausea and vomiting, feeling hot, blurred vision, and eventual syncope. Multivariate logistic regression was used to determine the independent predictors of delayed ambulation and orthostatic intolerance.
  
  
  RESULTS
  There were 24 cases with documented orthostatic intolerance and 5 with delayed ambulation. After multivariate logistic regression modeling, postoperative continuous infusion of fentanyl was found to be significantly associated with both orthostatic intolerance [adjusted odds ratio (95% confidence interval), 34.78 (11.12-131.72)] and delayed ambulation [adjusted odds ratio (95% confidence interval), 8.37 (1.23-72.15)].
  
  
  CONCLUSIONS
  Postoperative continuous infusion of fentanyl is associated with increased orthostatic intolerance and delayed ambulation in patients after gynecologic laparoscopic surgery.
authors.affiliation: Department of Anesthesia, Kyoto Medical Center, Kyoto, Japan.
authors.forename: Yoshika
authors.initials: Y
authors.lastname: Iwata
authors.forename: Yoko
authors.initials: Y
authors.lastname: Mizota
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Mizota
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Koyama
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Shichino
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D000771:Anesthesia, Intravenous; D015992:Body Mass Index; D015331:Cohort Studies; D004434:Early Ambulation; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D007262:Infusions, Intravenous; D010535:Laparoscopy / Q000009:adverse effects*; D008875:Middle Aged; D054971:Orthostatic Intolerance / Q000139:chemically induced* / Q000453:epidemiology; D011182:Postoperative Care / Q000009:adverse effects*; D011183:Postoperative Complications / Q000139:chemically induced* / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D005283:Fentanyl