title: Do injection drug users have more adverse events during procedural sedation and analgesia for incision and drainage of cutaneous abscesses?
abstract: OBJECTIVE
  Injection drug users (IDUs) often undergo procedural sedation and analgesia (PSA) in the emergency department (ED). We compared adverse events (AEs) for IDUs to those for non-IDUs receiving PSA for incision and drainage of cutaneous abscesses.
  
  
  METHODS
  This was a retrospective analysis of a PSA safety audit. IDU status was prospectively documented among consecutive patients undergoing PSA at two urban EDs. Structured data describing comorbidities, vital signs, sedation regimens, and adverse events were collected. Primary outcome was the proportion of patients in each group experiencing an AE, whereas the secondary outcomes included recovery times.
  
  
  RESULTS
  Of 525 consecutive patients receiving PSA for incision and drainage of an abscess, 244 were deemed IDUs and 281 non-IDUs. IDUs received higher doses of sedatives and analgesics, and 14 experienced AEs (5.7%), whereas 10 non-IDUs had AEs (3.6%), for a risk difference of 2.1% (95% CI -1.8, 6.5). Median recovery times were 18 minutes (interquartile range [IQR] 10-36) for IDUs and 12 minutes (IQR 7-19) for non-IDUs, for a difference of 6 minutes (95% CI 2-9 minutes). Median sedation times were also longer in IDUs, for a difference of 6 minutes (95% CI 5-10 minutes). Of 20 IDU patients and 1 non-IDU patient admitted to hospital, none had experienced an AE related to PSA.
  
  
  CONCLUSIONS
  For ED patients requiring PSA for incision and drainage, IDUs had an AE rate similar to that of non-IDUs but longer sedation and recovery times. In experienced hands, PSA may be as safe in IDUs as in patients who do not use injection drugs.
authors: Frank
authors: F
authors: Xavier Scheuermeyer
authors: Gary
authors: G
authors: Andolfatto
authors: Lisa
authors: L
authors: Lange
authors: Danielle
authors: D
authors: de Jong
authors: Hong
authors: H
authors: Qian
authors: Eric
authors: E
authors: Grafstein
mesh_terms: D000038:Abscess / Q000601:surgery*; D000328:Adult; D000698:Analgesia / Q000009:adverse effects*; D001955:British Columbia / Q000453:epidemiology; D016292:Procedural Sedation / Q000009:adverse effects*; D004322:Drainage / Q000379:methods*; D055030:Drug Users; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects*; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies
chemical_list: D006993:Hypnotics and Sedatives