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



This 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.



The 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.



Long-acting patient-controlled opioids were not associated with the increased hypoxemia during the first 2 postoperative days.
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.
Allan W
AW
Belcher
Ashish K
AK
Khanna
Steve
S
Leung
Amanda J
AJ
Naylor
Matthew T
MT
Hutcherson
Bianka M
BM
Nguyen
Natalya
N
Makarova
Daniel I
DI
Sessler
P J
PJ
Devereaux
Leif
L
Saager
D061605:Administration, Intravenous; D000368:Aged; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects* / Q000379:methods; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000097:blood / Q000139:chemically induced*; D016018:Least-Squares Analysis; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010100:Oxygen / Q000097:blood*; D010108:Oxyhemoglobins / Q000378:metabolism; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D015415:Biomarkers; D010108:Oxyhemoglobins; D010100:Oxygen